STS Survey Sri Lanka 2015 i · STS Survey Sri Lanka 2015 vii List of Tables Table 2.1: Variables...

iSTEPS Survey Sri Lanka 2015

iSTEPS Survey Sri Lanka 2015

Non Communicable Disease Risk Factor SurveySri Lanka2015

ii STEPS Survey Sri Lanka 2015

iiiSTEPS Survey Sri Lanka 2015

Table of Contents

Executive Summary xvi

1. Introduction 1

1.1 Objectives 2

2. Methodology 3

2.1 Study design 3

2.2 Study population 3

2.3 Inclusion criteria 3

2.4 Exclusion criteria 3

2.5 Sample size 3

2.6 Sampling method 4

2.7 Data collection 4 2.8 Data processing, weighting and analysis 8 2.9 Ethical clearance 8

3. Demographic Information 9

4. Tobacco use 11

4.1. Current tobacco users 11

4.2. Current smokers 11

4.3. Current daily smokers and non-smokers 12

4.4. Age of initiation of smoking 13

4.5. Manufactured cigarettes users 13

4.6. Mean amount of tobacco products used 14

4.7. Types of tobacco products used 14

4.8. Quantities of cigarettes smoked 14

4.9. Tried to stop smoking 15

4.10. Advice to stop smoking 15

4.11. Smokeless tobacco 15

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4.12. Exposure to second-hand smoke in home 16

4.13. Exposure to second-hand smoke in work places 16

5. Alcohol Consumption 17

5.1. Alcohol consumption status 17

5.2. Stopped drinking due to health reasons 18 5.3. Frequency of alcohol consumption 19

5.4. Mean number of drinking occasions 19

5.5. Mean number of drinks 19

5.6. Drinking level in adults 20

5.7. Drinking level among current drinkers 21

5.8. Mean maximum number of drinks consumed 21

5.9. Binged drinking (six or more drinks per occasion) 22

6. Diet 23

6.1. Fruit and vegetable consumption 23

6.2. Salt 25

7. Physical Activity 27

7.1. Physically inactive 27

7.2. Level of physical activity 27 7.3. Time spent on physical activity 28

7.4. Physical activity at work and during transport 30 7.5. Recreation related physical activity 30

8. History of Raised Blood Pressure 33

9. History of Diabetes 35 10. Total Blood Cholesterol 37

11. History of Cardiovascular Diseases 39

12. Life Style Advice 41

13. Cervical Cancer Screening 43

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14. Physical Measurements 45

14.1. Blood pressure measurements 45

14.2. Mean heart rate 46

14.3. Body Mass Index (BMI) 46

14.4. Waist circumference (cm) 48

15. Biochemical Measurements 49

15.1. Blood sugar measurements 48

15.2. Cholesterol level 50

16. Cardiovascular Disease Risk 53

17. Summary of Combined Risk Factors 55 18. Conclusion and Recommendations 57

Bibliography 57

Annexures 61

Annexure I: Data Tables 65

1.Tobacco Use 65

2.Diet 69

3.Physical Activity 71

4.History of Raised Blood Pressure 75

5.History of Diabetes 77

6.History of raised Cholesterol 79

7.Physical Measurements 81

8.Biochemical Measurements 83

Annexure II: STEPS Instrument 85

Annexure III: Factsheet on NCD Risk Factor 103

Annexure IV: Tobacco Factsheet 107

Annexure V: Tobacco Policy Data Book 109

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viiSTEPS Survey Sri Lanka 2015

List of Tables

Table 2.1: Variables included in the study from different modules of each STEP 7

Table 3.1: Distribution of respondents by socio-demographic characteristic (unweighted percentages) 9

Table 3.2: Distribution of respondents with unpaid work and unemployed (unweighted percentages) 9

Table 3.3: Distribution of the respondents by ethnicity and age group (unweighted percentages) 10

Table 3.4: Distribution of the households by monthly household earnings (in LKR) (unweighted percentages) 10

Table 4.1: Distribution of current smokers by age and sex 11

Table 4.2: Distribution of males by smoking status and age groups 12

Table 4.3: Distribution of daily smokers among current smokers by age and sex 12

Table 4.4: Mean age of initiation of current smokers by sex and age group 13

Table 4.5: Distribution of daily smokers using manufactured cigarettes 13

Table 4.6: Distribution of current smokers who tried to stop smoking 15

Table 4.7: Distribution of current smokers who have been advised by a doctor to stop smoking 15

Table 4.8: Distribution of current users of smokeless tobacco among all respondents by age and sex 15

Table 5.1: Distribution of male and female respondents by alcohol consumption status and age groups 17

Table 5.2: Distribution of total population by alcohol consumption status 18

Table 5.3: Distribution of former drinkers (who did not drink during the past 12 months) who did not drink due to health reasons 18

Table 5.4: Mean number of drinking occasions in the past 30 days among current (past 30 days) drinkers 19

Table 5.5: Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers 19

Table 5.6: Distribution of high-end level drinking among drinkers 20

Table 5.7: Distribution of intermediate-end level drinking among drinkers 20

Table 5.8: Distribution of lower-end level drinking among drinkers 21

Table 6.1: Mean number of servings of fruit on average per day 23

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Table 6.2: Mean number of servings of vegetables consumed on average per day 24

Table 6.3: Distribution of those who consumed less than 5 servings of fruits and/or vegetables per day 25

Table 6.4: Distribution of those who add salt always or often when cooking rice at home 25

Table 6.5: Distribution of those who always or often eat processed foods high in salt 26

Table 6.6: Mean number of meals eaten outside home 26

Table 7.1: Distribution of those who are physically inactive by sex and age groups 27

Table 7.2: Distribution of level of total physical activity of males according to WHO recommendations 27

Table 7.3: Distribution of level of total physical activity of females according to WHO recommendations 28

Table 7.4: Distribution of level of total physical activity of both sexes according to WHO recommendations 28

Table 7.5: Mean minutes of total physical activity per day 28

Table 7.6: Median minutes of total physical activity per day 29 Table 7.7: Distribution of those not meeting WHO recommendations on vigorous physical activity for health 31 Table 8.1: Distribution of those currently taking medication for raised blood pressure 33

Table 9.1: Distribution of the males by self-reported high blood sugar levels 35

Table 9.2: Distribution of the females by self-reported high blood sugar levels 35

Table 9.3: Distribution of the both sexes by self-reported high blood sugar levels 35

Table 9.4: Distribution of those currently taking drugs (medication) prescribed for diabetes among those previously diagnosed 36

Table 9.5: Distribution of those currently on insulin for diabetes among those previously diagnosed 36

Table 10.1: Distribution of population with high total cholesterol by the status of medication 37

Table 11.1: Distribution of those who ever had a heart attack or chest pain 39

Table 11.2: Distribution of population taking aspirin regularly to prevent or treat heart disease 39

Table 11.3: Distribution of population taking statins regularly to prevent or treat heart disease 39

Table 12.1: Distribution of population advised to quit using tobacco or don’t start 41

Table 12.2: Distribution of population advised to reduce salt in the diet 41

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Table 12.3: Distribution of population advised to eat at least five servings of fruit and/or vegetables each day 41

Table 12.4: Distribution of population advised to reduce fat in the diet 42

Table 12.5: Distribution of population advised to start or do more physical activity 42

Table 12.6: Distribution of population advised to maintain a healthy body weight or to lose weight 42

Table 13.1: Distribution of females who have ever had a cervical cancer screening test 43

Table 13.2: Distribution of females in the age group of 30-49 who have ever had a cervical cancer screening test 43

Table 14.1: Distribution of mean systolic blood pressure in mmHg 45

Table 14.2: Distribution of mean diastolic blood pressure in mmHg 45

Table 14.3: Prevalence of raised blood pressure excluding those on medication for raised blood pressure 46

Table 14.4: Prevalence of raised blood pressure including those on medication for raised blood pressure 46

Table 14.5: Distribution of males by BMI classification 47

Table 14.6: Distribution of females by BMI classification 47

Table 14.7: Distribution of both sexes by BMI classification 47

Table 14.8: Mean waist circumference in men 48

Table 15.1: Mean fasting blood glucose (mg/dl) 49 Table 15.2: Prevalence of impaired fasting glycaemia 49

Table 15.3: Percentage with raised blood glucose (<126 mg/dl) or currently on medication for diabetes 49

Table 15.4: Percentage who are currently on medication for diabetes 50

Table 15.5: Prevalence with total cholesterol ≥ 190 mg/dl or currently on medication for raised cholesterol 50

Table 15.6: Prevalence with total cholesterol ≥ 240 mg/dl or currently on medication for raised cholesterol 51

Table 16.1: Prevalence of 10-year CVD risk or existing CVD 53

Table 16.2: Percentage of eligible persons receiving drug therapy and counselling to prevent heart attacks and strokes 53

Table 17.1: Distribution by combined risk factors 55

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xiSTEPS Survey Sri Lanka 2015

List of figuresFigure 2.1: The format of the STEPS approach 7

Figure 4.1: Distribution by current tobacco users 11

Figure 4.2: Distribution by smoking status 12

Figure 4.3: Mean amount of tobacco products used by daily male smokers each day 14

Figure 4.4: Distribution of male daily smokers by quantities of manufactured or hand rolled cigarettes smoked per day 14

Figure 4.5: Distribution by the exposure to second-hand smoke in home in the past 30 days 16

Figure 4.6: Distribution by the exposure to second-hand smoke in workplaces in the past 30 days 16

Figure 5.1: Distribution by frequency of alcohol consumption 19

Figure 5.2: Distribution of high-end, intermediate and lower-end level drinking among current (past 30 days) drinkers 21

Figure 5.3: Mean maximum number of standard drinks consumed on one occasion in the past 30 days 21

Figure 5.4: Distribution of those who had six or more drinks on a single occasion at least once during past 30 days 22

Figure 6.1: Mean number of days of fruit & vegetable consumption per week 23

Figure 6.2: Mean number of servings of fruit and/or vegetables consumed on average per day 24

Figure 6.3: Distribution by number of servings of fruit and/or vegetables consumed on average per day 25

Figure 7.1: Distribution by work related physical activity 30

Figure 7.2: Distribution by transport related physical activity 30

Figure 7.3: Distribution by recreation related physical activity 30

Figure 10.1: Distribution by history of total blood cholesterol measurements 37

Figure 14.2: Distribution by overweight or obesity 48

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Acronyms

BMI Body Mass Index

BP Blood Pressure

CI Confidence Interval

COPD Chronic Obstructive Pulmonary Disease

CVD Cardiovascular Disease

DBP Diastolic Blood Pressure

HDL High-Density Lipoproteins

Hg Mercury

MET Metabolic Equivalents of Task

mmol/l Millimoles Per Litre

NCD Non-Communicable Disease

PDA Personal Digital Assistant

PPS Probability Proportionate to Size

PSU Primary Sampling Unit

SBP Systolic Blood Pressure

SEARO South-East Asia Regional Office

SSU Secondary Sampling Unit

WHO World Health Organization

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Message from the Secretary, Ministry of Health, Nutrition & Indigenous Medicine

In Sri Lanka more than 70% of the disease burden is due to Non communicable diseases (NCD). In the context of free healthcare delivered by the Ministry of Health, a considerable proportion of the annual health budget is spent on both sophisticated diagnostics such as Magnetic Resonance Imaging (MRI), Angiography and Echocardiography and also on therapeutic procedures such as Coronary Artery Bypass Graft Surgery (CABG) to counter the effects of NCD and its’ Complications.

Therefore, it is of utmost importance to plan, implement and evaluate the strategic measures laid to prevent and control the burden of NCD in the country. The results of the survey show the trends in key risk factors for major NCD. Also, it gives a good assessment of our strategic programmes and control measures implemented to counter Non Communicable Diseases.

While appreciating the effort taken by the survey team, I’m pleased to issue this message at the important occasion of launching the final report of the STEPS NCD risk factor survey 2015.

Anura JayawickramaSecretaryMinistry of Health, Nutrition and Indigenous Medicine

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Message from the Director General of Health Services

Non communicable diseases (NCD) are one of the heaviest burdens to a developing nation. Measures to prevent and control NCD are of utmost importance to a country targeting greater health goals.

As a country in the South Asia region, Sri Lanka is also conducting numerous programmes to prevent and control NCD under the direct guidance and supervision of the Ministry of Health. These programmes receive technical assistance from international agencies such as World Health Organization (WHO). Therefore, it is crucial to assess the impact of these programmes by analysing the trends of NCD and prevalence of its risk factors in the community. STEPWise approach to Surveillance (STEPS) introduced by the WHO is an ideal tool to assess the prevalence of NCD and risk factors in a country.

As a measure of assessing the ongoing NCD prevention and control programmes in the country Ministry of Health conducted a National NCD risk factor survey using the WHO STEPS tool in 2015 under the guidance of Deputy Director General (Medical Services) – I.

As Director General of Health Services, I’m pleased to provide a message in the important event of launching the final report of the said STEPS NCD risk factor survey. Further, I would like to congratulate the Sri Lankan survey team and to thank the WHO for their assistance in this endeavour.

Dr. Palitha MahipalaDirector General of Health Services

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Message from the Deputy Director General (Medical Services-I)

I am pleased to release this message as an utmost necessity of the health sector has been accomplished by successfully conducting the National Non Communicable Diseases (NCD) Risk Factor Survey after an interval of seven years.

An updated situational analysis of key factors such as Tobacco use, Diet and Physical activity, with regard to NCD, of the nation is vital to plan for future in making Sri Lankans healthier.

Also, this survey provides us with the opportunity to compare the outcomes with the regional status as well as the global status of NCD. Therefore, we were determined to follow a standard methodology which is the WHO STEPwise Surveillance (STEPS).

Much effort has been gone from the planning stage until the release of the survey results, by many who involved in the survey team. Accordingly, as the principal investigator, I like to thank all the members of our survey team for their enormous contribution to this much needed task of conducting National NCD Risk Factor Survey.

Dr. Lakshmi C. SomatungaDeputy Director General (Medical Services) – I

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Message from the Regional Director WHO South-East Asia Region-World Health Organization

Non communicable diseases, or NCDs, are the most common cause of morbidity and mortality worldwide. Surveillance is critical to provide the information needed for the development of policies and programmes. Appropriate legislation is also required for NCD prevention and control, as well as to support the evolution of programmes and policies for monitoring their progress and success. Prevention and control of non communicable disease is one of the Flagship Priority Area of the South-East Asia Region.

National surveillance should serve in a strategic capacity to foster critical partnerships, provide linkages to, and inform decision structures with inputs to information systems at all levels. The WHO NCD Action Plan calls on Member States to strengthen surveillance systems with standardized data collection on NCD risk factors and determinants using recognized methods and tools.

The WHO Regional Office for South East Asia is committed to supporting and facilitating the STEPS survey and NCD-related surveillance activities of Member States. We are happy to note that the Ministry of Health, Nutrition and Indigenous Medicine of Sri Lanka has come up with “NCD STEPS Sri Lanka Report 2015” which presents the key findings from the nationally representative survey and delivers new insights into the health status of its population.

We hope that Sri Lanka will use the rich data presented in this report to strengthen and improve NCD policies and programmes in the country for the greater well-being of its population.

Dr Poonam Khetrapal SinghRegional DirectorWHO South-East Asia Region

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Message from the World Health Organization Representative to Sri Lanka

Non communicable diseases (NCDs) constitute a major public health challenge in Sri Lanka. Most NCDs are the result of four risky behaviours (tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol) that lead to four key metabolic/physiological changes (raised blood pressure, overweight/obesity, raised blood glucose and raised cholesterol). The STEPS approach focuses on obtaining core data on these four risk behaviours and the resultant four key metabolic/physiological changes. Repeated STEPS surveys form the basis on which a country will monitor and evaluate its interventions to prevent and control of NCDs.

I am very pleased that Ministry of Health, Nutrition and Indigenous Medicine in Sri Lanka, has completed the STEPS survey on NCD risk factors 2014. This is the third STEPS survey conducted in the country with the first two being completed in 2003 and 2007. This survey of 2014 fulfils the requirement of data on baseline situation of the targets Sri Lanka has set in its Multisectoral National Action Plan on the Prevention and Control of NCDs, 2016-2020 and the basis for the monitoring of the progress of its actions. I encourage all health managers and professionals and researchers of all sectors to use data from this survey to improve the quality and the range of NCD related work.

Dr Jacob KumaresanWorld Health Organization Representative to Sri Lanka

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Acknowledgement

The successful completion of the National Non Communicable Diseases Risk Factor Survey 2015 was made possible due the contribution of many persons. The following individuals and organizations are acknowledged with gratitude for the support and contribution:

All the respondents who voluntarily gave their time and information,

The Medical Graduates who tirelessly worked as data collectors,

The Medical Officers (Focal Points) in Non Communicable Diseases at district level, and Medical Officers of Health for working as supervisors in carrying out the survey,

Dr. Lakshmi C. Somatunga, Deputy Director General (Medical Services)-I, The principal investigator for giving leadership for every stage of the survey,

Department of Census and Statistics for technical support provided

Dr. V. T. S. K. Siriwardhana – Director, and Dr. Parameswaran Anandan – Deputy Director of the Non Communicable Diseases Unit, Ministry of Health, and the staff of Non Communicable Diseases Unit for facilitating the survey,

Dr. Virginie Mallwarachchi and Dr. Samith Sirithunga Consultant Community Physicians of the Non Communicable Diseases Unit for technical support provided in training the data collectors, designing the survey, sampling, coordination and supervision of data collectors of the survey, and in compiling the survey report,

Dr. Rohan Rathnayaka, Consultant Community Physician, Metal Health Unit for technical support in sampling and designing the survey,

Dr. Sunil Ellawala and Dr. A.I Widanagamage, Medical Officers at the Non Communicable Diseases Unit for coordination and supervision of data collectors of the survey,

Dr. Kusal Wijayaweera, Dr. Nirmala Cooray, and Dr. Mayura Yapa - Medical Officers of Health Informatics for technical support in managing Personal Digital Assistants (PDAs), compiling and analysing data,

Dr. Virginie Mallwarachchi and Dr. Kusal Wijayaweera in compiling this comprehensive final survey report,

Dr. Lubna Bhatti, Ms. Melanie Cowan, and Mr. Stefan Savin of WHO Headquarters, Geneva, for continuous technical support in training the research team and data analysis,

Dr. Dhirendra N Sinha, Dr. Renu Garg, Mr. Naveen Agarwal of WHO SEARO, Delhi for technical and logistical support,

Prof. Anand Krishnan, AIIMS, New Delhi, for training the research team,

Dr. Jacob Kumaresan World Health Organization Representative to Sri Lanka and Prof. Nalika Gunawardena for providing logistical and technical support for conducting the survey.

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Executive Summary

Introduction

The burden of non-communicable diseases (NCD) in Sri Lanka has increased over past few decades, attributable to the changes in the life style. Reducing the incidence and the prevalence of both behavioural and biological risk factors for NCD has been identified as a major strategy in prevention of NCD in Sri Lanka. Therefore, it is vital to study the status and trends of behavioural and biological risk factors in the country for the purpose of planning, implementation and evaluation of NCD prevention and control programmes.

The “STEPwise approach to NCD Surveillance (STEPS)” designed by the World Health Organization (WHO) has been identified as the most appropriate method for identifying the prevalence of NCD risk factors in a country. Considering the timely need to conduct a NCD survey in Sri Lanka, Ministry of Health implemented a national STEPS survey in 2014-15.

Methodology

A national household survey study was conducted using WHO STEPwise approach. A multi stage cluster sampling method was used to draw a nationally representative sample. The survey included adult Sri Lankan males and females between the ages of 18-69 years.

The primary sampling unit (PSU) was the Divisional Secretariat (DS) area. Out of 331 DS areas in Sri Lanka, 80 were selected using a probability proportional to population size (PPS) of each DS area. A census block was considered as a six secondary sampling units (SSU). From each PSU, six SSUs were selected using PPS method, resulting in a total of 480 SSUs or census blocks. From each of these census blocks, 15 households (tertiary sampling unit or TSU) were selected by systematic random sampling. Selection of SSU and TSU was done randomly by the department of census and statistics, Sri Lanka. Therefore, the number of households selected for the survey was 7200 (80 X 6 X 15). Only one eligible individual from each household was selected randomly using Kish method.

The data collection consisted of three steps: Step one (interviews), Step two (physical measurements) and Step three (biochemical measurements). Data weighting and analysis was conducted in accordance with STEPS survey using Microsoft Excel, Access and Epi Info version 3.5.4 Software.

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Results

Response rate

The response rate for STEP1 was 72.0%, whereas for STEP2 was 68.7% and for STEP3 was 63.3%.

Demographic characteristics

Of the 5188 total respondents who participated in the STEP survey, majority (60.9%) were females while 39.1% were males. More than half (52.2%) of the total respondents had completed the sec-ondary education. Mean number of years of education was 9.7 in males and 9.9 in females. Majority of the respondents were Sinhalese (76.6%) while 12.4% were Sri Lankan Tamils and 8.5% were Sri Lankan Moor. Nearly 47% of the respondents estimated monthly household earning of more than Rs. 20,000/- per month.

Behavioural risk factors

Tobacco use The findings indicate that 45.7% men and 5.3% women currently used some form of tobacco product (either smoked or smokeless) while 35.3% of males and 4.1% of females were daily tobacco users.Prevalence of current smoking was 29.4% in males and 0.1% in females. Of the current male smokers, 67.6% were daily smokers. Mean age of initiation of smoking for male smokers was 20.5 years. Majority (82.9%) of the male daily smokers were using manufactured cigarettes. More than half of the male current smokers (51.8%) had tried to stop smoking. Only one third of the current smokers were advised by a doctor to stop smoking.

One fourth of the male respondents (26.0%) and nearly 5% of females reported currently using smokeless tobacco.

Approximately one fourth (25.2%) of the males and one fifths (21.6%) of the females reported being exposed to second-hand smoking at home during past 30 days while 36.1% of the males and 11.1% of females were exposed to second-hand smoking at their work place in the past 30 days.

Alcohol consumptionOne third (34.8%) of the males were current alcohol users (drank in the past 30 days), while 40.2% were lifetime abstainers. A great majority (96.5%) of females were lifetime abstainers. More than one forth (27.4%) of the former drinkers had stopped consuming alcohol due to health reasons (30.2% males and 11.7% females).

Of the males who drank during past 12 months, nearly 5.7% had consumed alcohol daily. Mean number of drinking occasions for male current drinkers during past 30 days was 5.6 and 1.7 for females. Mean number of standard drinks per drinking occasion among current male drinkers during past 30 days was 4.3 and 1.6 for females. Mean maximum number of standard drinks consumed during past 30 days were 5.5 among males and 1.4 for female.

Nearly 17% of the males had indulged in heavy episodic drinking (six or more alcoholic drinks on a single occasion) during last 30 days. Eight percent of the current male drinkers and 2.4% of the current female drinkers reported consuming unrecorded alcohol during past 7 days.

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Fruit and vegetable consumptionMean number of servings of fruits and/or vegetables consumed by both males and females per day was 4.3 servings (males 4.3 and females 4.4). Only 26.9% of the males and 28.0% of the females were consuming five or more servings of fruits and/or vegetables per day.

Salt and processed food consumptionMore than half of the adults (52.8%) reported adding salt to rice while cooking. Approximately 27% of the adults (28.3% males and 24.8% females) were always or often eating processed foods.

Physical ActivitySurvey findings revealed that 22.5% of the males and 38.4% of the females did not meet the WHO recommendation of physical activity (150 minutes of physical activity per week). More than half of the males (53.7%) were engaged in high intensity physical activity and majority of females were engaged in low (44.2%) and moderate (23.6%) intensity physical activity.

Cervical Cancer ScreeningOnly 15.2% of the females aged 18-69 years and 24.5% of those in the 30-49 years age group have ever had the cervical screening.

STEP 2

Nearly one fifths of all adults (21.0%) who had high blood pressure were not on medication (21.9% males and 20.2% females).

Body Mass IndexMore than half of the adults (55.4%) had a normal BMI value (18.5-24.9); with 58.9% males and 51.6% of females. Approximately 29% of the adults were found to have a BMI≥ 25 (overweight and obese). Nearly one fourths of the males (24.6%) and one thirds of the females (34.3%) were found to be either overweight or obese. Nearly 30% of the adults were estimated to be overweight (21.0% men and 26.0% females) and 5.9% of total respondents were obese (3.5% males and 8.4% females). Further, 15.3% of the adults were estimated to be underweight (16.5% males and 14.1% females).

Waist circumference Mean waist circumference for the males was 82.3 and for females was 82.1 cm.

STEP 3

Raised blood glucose or currently on medication for diabetes Overall, 7.4% of adults were estimated to be either having raised blood glucose or were currently on medication for diabetes (7.3% males and 7.6% females).

Cholesterol levelNearly one fourth of the adults (23.7%) were estimated to either have raised total cholesterol (≥ 190 mg/dl) or were currently on medication for raised cholesterol. Nearly one third of the females (28.4%) and one fifth of the males (19.1%) were estimated to be in this category.

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Cardiovascular disease riskApproximately 9% of the adults aged 40-69 years were estimated to either have 30% or more 10-year CVD risk or an existing CVD. Only half of those (55.6%) had received drug therapy and counselling to prevent heart attack and stroke.

Conclusions and recommendations

This National Survey was a dire need of the health sector in Sri Lanka as it gives an assessment for on-going efforts to control and prevent key risk factors for major NCDs. Hence, the results of this survey will be a very useful tool for planning and implementation of relevant programmes in Sri Lanka.

The findings highlight the need for new strategies to strengthen preventive measures to reduce the incidence of smoking among the younger age groups. More attention should be placed towards prevention and control activities focusing on smokeless tobacco use.

It is important to start a properly functioning island-wide tobacco cessation facilities including 24 hour tobacco cessation hotline. It will be useful to have regular training programmes for medical professionals in the country on advising the patients on tobacco cessation and brief interventions.

Current strategies to reduce smoking such as pictorial warnings, and other legislative measures should be strengthened. There is a need to strengthen the implementation and enforcement of smoke-free policies in public and work places.

Evaluation of current strategies and policies in prevention and control of alcohol consumption should be considered.

Findings warrant for interventions which would not only improve health literacy on consumption of fruits and vegetables, but also economic policy reforms geared towards improving availability and affordability of such food items, and also improving the buying power of the population. The identified gap between the knowledge and actual practices of salt consumption should be addressed through properly designed awareness programmes. Findings related to dietary habits indicate the need to carry out appropriate and culturally-tailored programmes to promote healthy diet in the community.

It is recommended to strengthen the current awareness programmes on healthy lifestyle, while improving facilities and promoting incentives for engaging in physical activities.

Finding reveal that under nutrition is still a problem in the country, this calls for strengthening prevention and control programmes.

Importance of popularizing already established healthy lifestyle centres, where individuals could get their blood pressure measured, and get health advices free of charge at the grass-root level is also recommended.

Approximately 9% of the adults were estimated to have ≥30% cardiovascular risk or with an existing CVD. Out of these, only half (55.6%) are receiving drug therapy and counselling to prevent heart attack and stroke which demands for immediate action.

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More than 90% of the Sri Lankan adults were estimated to have at least one of the NCD risk factors (73.5% with 1-2 risk factors, and 18.3% with 3-5 risk factors), with similar prevalence in males and females. This situation should be intervened with timely implemented policies, and strategies at the national level.

NCDs will potentially emerge as a the biggest public health challenge in Sri Lanka due to the high prevalence of NCD risk factors, and the already existing gap between prevalence and treatment. However, if greater investments in NCD prevention and services are made through the right policies and public health measures, the imminent NCD epidemic could be controlled.

Health systems should be made more responsible for treatment and health-seeking behaviour. Both private and public health systems should be involved in integrating NCD services to promote healthy life styles as well as managing NCD patients. This requires the involvement of all government institutions as well as private sector, civil society, faith-based organizations, academia and community to have a comprehensive and multi-sectoral approach for preventing and controlling NCDs in Sri Lanka.

1STEPS Survey Sri Lanka 2015

1. Introduction

Nearly 38 million people die of non-communicable diseases (NCD) in the world each year. Over 14 million die prematurely (age 30 -70 years) from NCDs, of whom two thirds live in lower and middle income countries (LMICs). Majority of these deaths are due to four common non-communicable diseases; cardiovascular diseases (heart attack and stroke), diabetes, cancer, and chronic respiratory diseases.

Four main behavioural risk factors namely tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity and four physiological risk factors such as raise blood pressure, overweight or obesity, hyperglycaemia and hyperlipidaemia have been identified as main risk factors for NCDs. Main strategy to reduce the NCD burden is to reduce the above modifiable risk factors in the community. Therefore, it is important to assess the prevalence of risk factors at regular intervals to study the trends of the risk factors and to evaluate the on-going prevention and control programmes.

Around 70% of the disease burden in Sri Lanka is due to non-communicable diseases. Nearly thirty percent of total hospital deaths are due to cardiovascular diseases which are the first leading cause of death in Sri Lanka for past few years. According to the hospital data, there is an increasing trend of morbidity and mortality related to NCD in Sri Lanka during the recent past.

A NCD survey using the WHO STEPwise approach survey was conducted in 2007, but did not measure the blood glucose or cholesterol. Given the need for recent and comprehensive data for NCD risk factors, the Ministry of Health implemented a national STEPS survey in 2014-15 which included behavioural interview and physical and biochemical measurements.

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1.1 Objectives

General objective

To determine the prevalence of key behavioural and biological risk factors for Non-Communicable Diseases in Sri Lankan men and women aged 18–69 years

Specific objectives

1. To assess the prevalence of key NCD behavioural risk factors (tobacco use, alcohol consumption, unhealthy dietary habits and physical inactivity)

2. To assess the prevalence of key NCD biological risk factors (high blood pressure, high blood sugar, over weight and obesity, high total cholesterol)

3. To assess the knowledge and practice on selected tobacco control policies

4. To assess the health seeking behaviour related to NCDs


2. Methodology2.1 Study design

A national cross-sectional survey was conducted using the WHO STEPwise survey protocol to obtain nationally representative estimates from the adult population, aged 18 to 69 years, in Sri Lanka.

2.2 Study population

The target population of the study was adults aged 18 to 69 years old residing in Sri Lanka.

2.3 Inclusion criteria

All individuals aged 18 to 69 years of age, and residing in the particular address for more than 6 months were included.

2.4 Exclusion criteria

Individuals who fall into following categories were excluded from the survey. •Whowerelivingintheparticularaddressforlessthan6months •Whowereforeignersandlivinginthecountryonatemporarybasis •Whowerementallyunfit •Whowerephysicallytoofrailtobeincludedinthestudy

2.5 Sample size

The number of households to be included in the sample with 95% confidence was calculated using the following formula and assumptions.

n=Z2 1-αP (1-P)/ d2

where;

Z - Level of confidence (for α=0.05 and 95% confidence level) = 1.96P - Estimated baseline levels of the behaviours or indicators = 0.5 currently being measured d - Margin of error = 0.05 n = 1.96 x 1.96 {0.5 (1-0.5)} 0.05 x 0.05 n = 384 Design effect (Deff) = 1.5 Number of age-sex estimates = 8 Anticipated response rate = 0.8

Minimum sample size = 384 x Design effect x number of age-sex estimates anticipated response rate Minimum sample size = 384 x 1.5 x 10 0.8 Minimum sample size= 7200 Therefore the final sample size for the survey was 7200.


2.6 Sampling method

A multi stage cluster sampling method was used to select a nationally representative sample from the total population. Department of Census and Statistics of Sri Lanka performed the selection of the study sample. Population of each divisional secretariat (DS) divisions as per the preliminary results of the Census done in 2012 was used for sampling.Sri Lanka is administratively divided in to 9 provinces and 25 districts. Each district is divided to Divisional Secretariat (DS) areas. Each DS area is divided to many Census Blocks, and each Census Block consists of many households.

Primary sampling unit (PSU)

The primary sampling unit (PSU) was a Divisional Secretariat (DS) area. Out of 331 DS areas available, 80 DS divisions were selected using proportionate to the size (PPS) sampling.

Secondary sampling unit (SSU)

A census block was considered as a SSU. From each DS division (PSU), six secondary sampling units (SSU) were selected using the proportionate to the size (PPS) sampling technique. Therefore, a total of 480 SSUs or census blocks were selected from 80 PSUs.

Tertiary sampling unit (TSU)

Number of houses in each census block depends on the area density and the population density in each DS division. Tertiary sampling unit (TSU) was the household and 15 households from each CB by random systematic sampling by the Department Census and Statistics. Therefore, a sample of 7200 (80x6x15) households were selected. In some instances, there were more than one household living in one house. People who are cooking and eating together were considered as one household. Whenever there were more than one household in a house, one household was selected randomly to be included in the study.

Selection of participants

Only one participant from each household was included in the survey. All the eligible members in the selected family were listed in descending order according to the age. Once this was done, these data was fed to the personal digital assistants (PDAs). The PDAs then automatically selected the eligible participant using the Kish method.

2.7 Data collection

Data collectors

Pre-intern Medical Doctors (Medical graduates awaiting the internship appointments) were recruited as the data collectors. STEP one and two were done at the household level. The closest available healthcare facility near the cluster was identified by the Public Health Midwife to carry out the STEP 3. Participants were given an appointment to come to the selected heath care facility to get the biochemical test done.


Training of data collectors

Five days training was conducted for the selected data collectors. It was conducted by the experts from the MOH and WHO (HQ and SEAR). The field teams were trained thoroughly on the questionnaire, on getting the anthropometric measurements and on performing the biomedical tests. They were also trained in detail on electronic data collection using the PDAs. In addition, this training consisted of selection of participants using the Kish method, ethical issues and importance of getting the consent.

Data collection Instruments

STEPS survey was conducted STEPS instrument version 3.1. (See Annex II)

STEP 1

STEP 1was carried out using an interviewer administered questionnaire, installed in the PDA. STEP 1 consists of core and optional modules to collect the demographic information and to assess the basic behavioural risk factors for NCDs such as tobacco use, alcohol consumption, dietary behaviour, and physical activity. In addition, questions to assess the factors related to increase in physiological risk factors such as blood pressure and blood glucose were also included.All the core questionnaires were included and several expanded questions were also included.

Core Modules

The survey questionnaire was designed to collect information related to the following variables.

•Demographics information: Sex, date of birth (age), years at school, educational level, ethnicity, occupation, number of household members >18 years, and monthly income •Behavioural measurements: Tobacco use, alcohol consumption, diet (fruit and vegetable consumption), physical activity, •Physiological risk factors: History of raised blood pressure, raised blood glucose, raised blood cholesterol, history of heart disease.

Consultative meetings were held with the research group and with some experts to identify the optional modules to be included in the survey. Consensus was made to include three optional modules such as salt, tobacco policy and NCD healthcare utilization in the survey. Optional modules were selected based on the need of the country and feasibility of conducting the data without prolonging the time taken to conduct the interview.

Necessary changes were made in the questions to fit it in to the local context. In addition, some new questions related to the behaviour of the Sri Lankans were also included in the questionnaire. A working group consisting of experts in the Ministry of Health and academia finalized the survey questionnaire. Final questionnaire was translated in to both Sinhala and Tamil and translated back in to English to improve the clarity. Questionnaires were pre-tested and necessary amendments were done in the questionnaire following the pre-test.

Show cards were developed based on the locally available fruits, vegetables, types of physical activity, tobacco products and types of alcohol. They were pretested prior to the survey. Each data collector was given a set of show cards to be used at data collection.


Finalized questionnaire was included in to the iPAQ Personal Digital Assistant (PDAs). The software installed in the PDAs allowed double data storage: one copy on the machine and another on the memory card.

Figure 2.1 indicate the format of the STEPS approach and Table 2.1 specifies the variables included in the study from different modules of each step.

Figure 2.1: The format of the STEPS approach


Table 2.1: Variables included in the study from different modules of each STEP

STEP 1 - Questionnaires

Core Expanded Optional

Demographic Information Tobacco policy

Behavioural information Dietary salt

•Tobacco Healthcare coverage

•Alcoholconsumption Healthcare utilization

•Diet

•Physicalactivity

H/O raised blood pressure

H/O diabetes

H/O raised total cholesterol

Life style advice

Cervical cancer screening

STEP 2 - Anthropometric measurements


Physical measurements •Waistcircumference

•Bloodpressure

•Heightandweight

STEP 3 - Biochemical measurements


•Fastingbloodsugar

•Totalcholesterol

Field management of data collection

In view of informing all the stakeholders, a meeting was conducted for relevant divisional level and district level managers (MOOH and MO/NCD) to discuss about the implementation, monitoring, supervision plans and feedback mechanism of the survey. All the necessary equipment received from WHO for data collection and the other necessary items and also the relevant documents and papers were distributed among the research assistants through the relevant district MO/NCD.

Quality control

Supervision of the data collection is vital in any form of research since it can contribute to increase in the quality of the data. Therefore, Ministry of Health decided to supervise the data collection using teams from central, provincial, district and MOH level staff.Each officer selected for the supervision from the central units was allocated few districts, and carried out 10 supervision visits per months to the respective districts during the three months of the STEPS survey. In addition to the supervision done by the central team attached to the NCD focal point, supervision was done by district managers and MOOH.


2.8 Data processing, weighting and analysis

After the end of the survey, data in the PDAs were downloaded to one database. Data cleaning, data weighting and data analysis was done in accordance with the WHO STEPS guidelines. Epi Info software was used to assist data analysis. Weighed frequency tables were calculated for various variables.

2.9 Ethical clearance

Ethical clearance was obtained from the Ethical Committee, Medical Research Institute, Colombo, Sri Lanka.


3. Demographic Information

A total of 5188 respondents participated in the study, and 2030 (39.1%) were males and 3158 (60.9%) were females (Table 3.1). Of the total respondents, 52.2% had completed secondary level education while 5% were without any formal education. Overall, more males were employed (81.6%) than females (26%). Among all respondents, 23.3% were self-employed, 17.0% were non-government employees, and 7.4% were government employees. Nearly three fourth of females (74.0%) were unpaid, while only 18.4% of males were in that category (Table 3.1).

Table 3.1: Distribution of respondents by socio-demographic characteristic (unweighted percentages)

Variables Males Females Both Sexes

Age group (in years) n (%) n (%) n (%)

18-29 295 36.8 508 63.3 802 15.5

30-44 679 37.2 1143 62.7 1823 35.1

45-59 691 40.8 1004 59.2 1695 32.7

60-69 365 42.1 503 57.9 868 16.7

18-69 2030 39.1 3158 60.9 5188 100.0

Education level n=2025 n=3150 n=5175

No formal schooling 85 4.2 176 5.6 261 5.0

Up to grade 5 324 16.0 405 12.9 729 14.1

Passed grade 6-10 638 31.5 841 26.7 1479 28.6

Passed G.C.E. (O/L) 561 27.7 942 29.9 1503 29.0

Passed G.C.E. (A/L) 333 16.4 663 21.0 996 19.2

Degree and above 84 4.1 123 3.9 207 4.0

Employment status n=2027 n=3152 n=5179

Government employee 207 10.2 177 5.6 384 7.4

Non-government employee 603 29.7 279 8.9 882 17.0

Self-employed 845 41.7 363 11.5 1208 23.3

Unpaid 372 18.4 2333 74.0 2705 52.2

Table 3.2: Distribution of respondents with unpaid work and unemployed (unweighted percentages)

Variables Males Females Both Sexes

n=372 n=2333 n=2705

Type of work n (%) n (%) n (%)

Non-paid 26 7.0 35 1.5 61 2.3

Student 61 16.4 85 3.6 146 5.4

Home maker 9 2.4 1575 67.5 1584 58.6

Retired 129 34.7 73 3.1 202 7.5

Unemployed (able to work) 92 24.7 471 20.2 563 20.8

Unemployed (unable to work) 55 14.8 94 4.0 149 5.5


A majority of male respondents (34.7%) were retired individuals while majority of females (67.5%) were home makers.

Table 3.3: Distribution of the respondents by ethnicity and age group (unweighted percentages)

Both Sexes

Age group (in years)

n % Sinhala % Sri Lankan Tamil

% Indian Tamil

% Sri Lankan Moor

% Other

18-29 802 73.4 13.8 1 10.3 1.4

30-44 1822 75.9 12.5 1.2 8.7 1.6

45-59 1693 77 12.5 0.6 8.6 1.3

60-69 868 80.5 10.6 2 6.2 0.7

18-69 5185 76.6 12.4 1.1 8.5 1.3

Of the total respondents, majority were Sinhalese (76.6 %) while 12.4% were Sri Lankan Tamils and 8.5% were Sri Lankan Moor. The ethnicity distributions of the respondents within each age group were similar.

Table 3.4: Distribution of the households by monthly household earnings (in LKR) (unweighted percentages)

Households

n % Quintile 1: 10,000

% Quintile 2:10,001 – 20,000

% Quintile 3:20,001 – 30,000

% Quintile 4:30,001 – 40,000

% Quintile 5: Over 40,000

4711 19.2 33.0 25.4 13.3 9.2

Almost third of the respondents (33.0%) had an estimated monthly household earning of Sri Lankan Rupees 10,000 - 20,000.


4. Tobacco use

Prevalence, frequency, and pattern of tobacco use in the adults according to age, sex, and forms of tobacco used were estimated in this survey. Users of tobacco comprise of smokers and smokeless tobacco users. All respondents were categorised first as current smokers, and non-smokers. Current smokers were further categorised as daily smokers, and non-daily smokers, while non-smokers were further categorised as former smokers and never smokers. Similar categorisation was done for smokeless tobacco users.

4.1. Current tobacco users

Around one fourth of the adults (25.8%) were current users of any form of tobacco (smoked or smokeless tobacco) (Figure 4.1). Tobacco use was much higher among men (45.7%) when compared to women (5.3%).

4.2. Current smokers

Table 4.1: Distribution of current smokers by age and sex

Males Both Sexes

Age Group (years) n % Current smoker 95% CI n % Current smoker 95% CI

18-29 294 22.3 17.0-27.6 798 11.7 8.8-14.6

30-44 678 33.6 29.7-37.4 1821 17.2 15.0-19.3

45-59 689 34.0 30.0-38.0 1691 16.8 14.7-19.0

60-69 365 30.0 24.8-35.2 867 15.1 12.3-17.9

18-69 2026 29.4 26.8-31.9 5177 15.0 13.6-16.4

Prevalence of current smoking among males was 29.4%, which is close to the prevalence in all age groups above 30 years among males. Prevalence of smoking was very low among females (0.1%) and was seen only in the age group of 45-59 years.

25.8

45.7

29.426.0

50

45

40

35

30

25

20

15

10

05

00

5.3

15.0

0.1

15.8

5.3

Both SexesMaleFemale

Tobacco Users Tobacco Smokers Smokeless Tobacco Users

Figure 4.1: Distribution of current tobacco users

Perc

enta

ge


4.3. Current daily smokers and non-smokers

Overall, 15% of the adults were estimated to be current smokers, with 10.2% being daily smokers and 4.8% non-daily smokers. It was also estimated that 76.5% had never smoked and 8.5% were former smokers.

Table 4.2: Distribution of males by smoking status and age groups

Men

Age Group (years)

n Current smoker Non-smokers

% Daily 95% CI % Non-daily

95% CI % Former smoker

95% CI % Never smoker

95% CI

18-29 294 12.8 9.0-16.7 9.5 5.7-13.3 9.6 6.0-13.2 68.1 61.9-74.2

30-44 678 22.6 19.0-26.1 11.0 8.5-13.4 14.4 11.3-17.5 52.1 47.9-56.2

45-59 689 25.5 21.7-29.3 8.5 6.2-10.8 22.0 18.3-25.7 44.0 39.7-48.2

60-69 365 22.0 17.3-26.8 7.9 4.8-11.1 33.4 27.8-39.0 36.7 31.2-42.2

18-69 2026 19.9 17.8-22.0 9.5 7.9-11.2 16.7 14.6-18.7 53.9 50.9-57.0

Of the males, 19.9% were daily smokers. Over a half (53.9%) of the males had never smoked and 16.7% were former smokers. The estimated prevalence of individuals who had never smoked during their life appears to be gradually decreasing with increasing age.

Table 4.3: Distribution of daily smokers among current smokers by age and sex

Age Group (years)

Men Both Sexes

n % Daily smokers

95% CI n % Daily smok-ers

95% CI

18-29 67 57.5 45.1-69.9 67 57.5 45.1-69.9

30-44 235 67.3 60.7-73.9 235 67.3 60.7-73.9

45-59 235 75.0 68.8-81.2 239 75.3 69.2-81.5

60-69 111 73.5 64.1-82.9 111 73.5 64.1-82.9

18-69 648 67.6 63.1-72.2 652 67.8 63.2-72.4

100

90

80

70

60

50

40

30

20

10

00Men Women Both sexes

53.9

16.7

09.5

19.9

99.8

76.5

8.5

10.2

4.8

0.1

% Never Smoker

% Former Smoker

% Non Daily

% DailyPerc

enta

ge

Figure 4.2: Distribution by smoking status


The highest prevalence of daily smokers among the current smokers was seen in the age category of 45-59 years (75%).

4.4. Age of initiation of smoking

Table 4.4: Mean age of initiation of current smokers by sex and age group

Age Group (years)

Men Both Sexes

n Mean age 95% CI n Mean age 95% CI

18-29 63 18.2 17.3-19.0 63 18.2 17.3-19.0

30-44 228 21.1 20.4-21.9 228 21.1 20.4-21.9

45-59 232 21.1 20.4-21.9 236 21.5 20.6-22.3

60-69 110 21.9 20.4-23.3 110 21.9 20.4-23.3

18-69 633 20.5 20.0-20.9 637 20.6 20.1-21.1

Mean age of initiation of smoking for male smokers was 20.5 (95% CI: 20.0 -20.9) years.

4.5. Manufactured cigarettes users

Table 4.5: Percentage of daily smokers using manufactured cigarettes

Age Group (years)

Men Both Sexes

n % Manufactured cigarette smoker

95% CI n % Manufactured cigarette smoker

95% CI

18-29 40 100 100.0-100.0 40 100 100.0-100.0

30-44 155 87.5 82.2-92.7 155 87.5 82.2-92.7

45-59 172 74.0 66.9-81.0 176 72.6 65.5-79.7

60-69 80 61.4 48.9-73.8 80 61.4 48.9-73.8

18-69 447 82.9 79.1-86.7 451 82.4 78.6-86.2

Majority (82.9%) of the males who smoked daily were using manufactured cigarettes. All the daily smokers between 18-29 years were using manufactured cigarettes. Out of the current male smokers, 84.7% were using manufactured cigarettes.


4.6. Mean amount of tobacco products used

Figure 4.3: Mean amount of tobacco products used by daily male smokers each day

Mean number of manufactured cigarettes used among male daily smokers was 3.7 (95% CI 3.1-4.4). Mean number of hand rolled cigarettes used was 0.4 (95% CI 0.2-0.5).

4.7. Types of tobacco products used

Although the majority (85.2%) of the current male smokers were using manufactured cigarettes, more than one fourth (28%) was using Shisha. Using Shisha was more in age group 45-59 and 60-69 years. In addition, 6.9% was using the hand rolled cigarettes and 2% was still using pipes of tobacco (Annexure 1.1).

4.8. Quantities of cigarettes smoked

Nearly two thirds of the male daily smokers (62.3%) were smoking less than 5 manufactured or hand rolled cigarettes per day. However, nearly 13.5% were smoking more than 10 manufactured or hand rolled cigarettes per day.

18-29 30-44 45-59 60-69 18-69

100

90

80

70

60

50

4

3.5

3.7

0.4

0.00.2

2.0

0.1

3

2.5

2

1.5

1

0.5

0

Manufactured Cig

Hand-rolled Cig

Pipes of tobacco

Cigars, Cheerots, Ciagrillos

Shisha Sessions

Other types of tobacco

Type of tobacco product

40

30

20

10

00

> 25 Cigs

15-24 Cigs

10-14 Cigs

5-9 Cigs

<5 Cigs

65.6 57.4 66.4 58.3 62.3

23.9 27.9

Age GroupsFigure 4.4: Distribution of male daily smokers by quantities of manufactured or hand rolled cigarettes smoked per day

0.33.710.7 9.4 12.5 8.1

3.5

18.8

5.5

27.5

1.7

24.1

1.9

1.91.86.8

Perc

enta

geM

ean

Num

ber


4.9. Tried to stop smoking

Table 4.6: Distribution of current smokers who tried to stop smoking

Age Group (years)

Men Both Sexes

n % Tried to stop smoking 95% CI n % Tried to stop smoking 95% CI

18-29 67 60.8 48.2-73.4 67 60.8 48.2-73.4

30-44 235 53.6 47.0-60.3 235 53.6 47.0-60.3

45-59 235 43.9 36.3-51.5 239 43.9 36.4-51.3

60-69 111 46.0 36.2-55.7 111 46.0 36.2-55.7

18-69 648 51.8 46.9-56.8 652 51.8 46.9-56.7

More than half of the male currents smokers (51.8%) had tried to stop smoking.

4.10. Advice to stop smoking

Table 4.7: Distribution of current smokers who have been advised by a doctor to stop smoking

Age Group (years)

Men Both Sexes

n % Advised to stop smoking 95% CI n % Advised to stop smoking 95% CI

18-29 55 33.1 19.8-46.5 55 33.1 19.8-46.5

30-44 190 30.4 23.7-37.0 190 30.4 23.7-37.0

45-59 182 41 32.7-49.4 185 40.6 32.4-48.8

60-69 91 39.7 29.0-50.4 91 39.7 29.0-50.4

18-69 518 35.2 30.1-40.2 521 35 30.0-40.1

Only around one third (35.2%) of the current smokers had been advised by a doctor to stop smoking.

4.11. Smokeless tobacco

Table 4.8: Distribution of current users of smokeless tobacco among all respondents by age and sex

Age Group (years)

Men Women Both Sexes

n % Current users

95% CI n % Current users


95% CI

18-29 294 16.6 11.7-21.4 504 0.9 0.0-1.9 798 9.1 6.5-11.7

30-44 676 29.0 24.8-33.1 1143 3.6 2.3-4.9 1819 16.6 14.2-18.9

45-59 689 30.8 26.7-34.8 1002 10.0 7.6-12.4 1691 20.2 17.7-22.7

60-69 365 37.3 31.6-43.0 502 11.4 7.9-14.9 867 24.4 21.1-27.8

18-69 2024 26.0 23.3-28.8 3151 5.3 4.3-6.3 5175 15.8 14.3-17.4

More than one fourth of the males (26.0%) and nearly 5% of females reported currently using smokeless tobacco. This was more prevalent among the older age groups.

Nearly 12% of the current users were daily users (Annexure 1.2).


4.12. Exposure to second-hand smoke in home

Approximately one fourth (25.2%) of the males and one fifth (21.6%) of the females were exposed to second-hand smoke at home during past 30 days. The age group mostly exposed to second-hand smoke was 18-29 years, where nearly one third (27.6%) were exposed to second-hand smoke at home.

4.13. Exposure to second-hand smoke in work places

18-29

35

10.6

23.3

41.4

12.6

28.2

36.4

10.6

23.3 21.6

09.8

16

36.1

11.1

24.1

35

40

45

30

25

20

15

10

05

0030-44 45-59 60-69 18-69

Age Group

Men

Women

Both Sexes

Perc

enta

ge

Figure 4.6: Distribution by the exposure to second-hand smoke in workplaces in the past 30 days

One fourth of all adults (24.1%) were exposed to second-hand smoke at their work place in the past 30 days.

Figure 4.5: Distribution by the exposure to second-hand smoke in home in the past 30 days

18-29

35

29.3

25.727.6

24.6

19.922.3

23.1

21.622.4

18.9

14.116.5

25.2

21.623.5

30

25

20

15

10

05

0030-44 45-59 60-69 18-69

Men

Women

Both Sexes

Perc

enta

ge

Age Group


5. Alcohol Consumption

During the survey respondents were questioned on their alcohol consumption status. Respondents, who claimed that they had never consumed alcohol during their life, were classified as Lifetime Abstainers and who claimed to consume alcohol during past 30 days was classified as Current Drinkers. Respondents, who claimed to have consumed alcohol during their life but not during last twelve months, were classified as Former Drinkers.

5.1. Alcohol consumption status

Table 5.1: Distribution of male and female respondents by alcohol consumption status and age groups

Alcohol consumption status

Age Group(years)

n % Current drinker (past

30 days)

95% CI % Drank in past

12 months,

not current

95% CI % Past 12

months abstain-

er

95% CI % Life-time ab-stainer

95% CI

Male

18-29 294 23.1 17.6-28.7 13.0 8.4-17.5 7.3 3.9-10.6 56.6 50.1-63.1

30-44 676 42.3 38.0-46.6 15.7 12.6-18.8 7.6 5.3-9.9 34.5 29.8-39.1

45-59 689 42.7 38.3-47.1 17.1 13.8-20.4 11.9 8.9-15.0 28.3 24.2-32.3

60-69 364 33.6 28.3-39.0 17.6 13.5-21.7 17.8 13.2-22.5 30.9 25.7-36.1

18-69 2023 34.8 32.0-37.6 15.3 13.3-17.3 9.7 7.9-11.4 40.2 37.0-43.4

Female

18-29 504 0.2 0.0-0.4 1.3 0.1-2.5 0.9 0.0-1.8 97.6 95.9-99.3

30-44 1143 0.3 0.0-0.5 1.1 0.4-1.7 2.1 1.0-3.2 96.6 95.3-97.8

45-59 1002 0.9 0.4-1.5 1.2 0.4-2.0 2.3 1.2-3.3 95.6 94.1-97.1

60-69 502 1.0 0.0-2.2 1.9 0.6-3.2 2.3 0.9-3.7 94.8 92.2-97.4

18-69 3151 0.5 0.2-0.8 1.3 0.7-1.9 1.8 1.2-2.3 96.5 95.5-97.4

This study estimates that, 67.9% of the adults had abstained from alcohol during their life. While majority of the females (96.5%) were lifetime abstainers of alcohol, only 40.2% of males fell in to this category. Of the adults, 17.9% were estimated as current drinkers. In males 34.8% were current drinkers and majority were seen in the age groups of 30-44 years (42.3%) and 45-59 years (42.7%). Only 0.5% of the females were current drinkers.


Table 5.2: Distribution by alcohol consumption status

Both sexes

Age Group(years)

n % Current drinker (past 30

days)

95% CI % Drank in past 12 months,

not current

95% CI % Past 12 months

abstainer

95% CI % Lifetime abstainer

95% CI

18-29 798 12.2 9.2-15.2 7.4 5.0-9.9 4.2 2.4-6.1 76.2 72.3-80.1

30-44 1819 21.7 19.3-24.1 8.5 6.8-10.2 4.9 3.6-6.2 64.9 62.0-67.7

45-59 1691 21.4 18.9-23.8 9.0 7.3-10.7 7.0 5.3-8.6 62.7 59.8-65.5

60-69 866 17.4 14.4-20.4 9.8 7.5-12.0 10.1 7.6-12.7 62.7 58.9-66.5

18-69 5174 17.9 16.5-19.4 8.4 7.3-9.5 5.8 4.8-6.8 67.9 66.0-69.8

5.2. Stopped drinking due to health reasons

Table 5.3: Distribution of former drinkers (who did not drink during the past 12 months) who did not drink due to health reasons

Age Group(years)

Men Women Both sexes

n % stopping due

to health reasons

95% CI n % stopping due to health

reasons

95% CI n % stopping due to health

reasons

95% CI

18-29 23 22.4 4.1-40.7 5 15.7 0.0-40.9 28 21.7 4.9-38.5

30-44 49 15.6 5.1-26.1 21 0.0 0.0-0.0 70 12.3 3.9-20.6

45-59 73 35.3 23.2-47.4 23 15.3 0.0-32.3 96 32.0 21.6-42.4

60-69 62 49.5 36.1-62.9 13 26.8 0.0-57.6 75 46.9 34.9-59.0

18-69 207 30.2 22.5-37.9 62 11.7 2.8-20.6 269 27.4 20.8-34.0

Among the former drinkers 27.4% of adults (30.2% males and 11.7% females), stopped alcohol consumption due to health reasons. Among males who have stopped taking alcohol, highest proportion was seen among the age group of 60-69 years followed by the age group of 45- 59 years. In females highest proportion was seen among the age group of 60 – 69 years followed by the age group of 18-29 years.


5.3. Frequency of alcohol consumption

Male FemaleBoth Sexes

100

90

80

70

60

Figure 5.1: Distribution by frequency of alcohol consumption

50

40

30

20

10

00

Perc

enta

ge

% Daily % 5-6 days/ week

% 3-4 days/ week

% 1-2 days/ week

% 1-3 days/ month

% < once a month

5.70.0

5.51.5 1.5 1.5

7.40.7

7.2

16.2

4.7

15.8

25.6

3.3

24.8

43.6

89.8

45.1

It is estimated that 5.5% of the group who drank during last 12 months from the adults was drinking daily and it is estimated to be comprised only of males. More than two thirds (69.9%) of the group who drank during last 12 months was estimated to drink 1 to 3 days a month or less.

5.4. Mean number of drinking occasions

Table 5.4: Mean number of drinking occasions in the past 30 days among current (past 30 days) drinkers.

Age Group(years)

Men Both Sexes

n Mean 95% CI n Mean 95% CI

18-29 70 3.7 2.5-4.8 71 3.7 2.5-4.8

30-44 279 5.5 4.5-6.5 283 5.4 4.5-6.4

45-59 282 6.6 5.4-7.8 292 6.5 5.3-7.7

60-69 122 7.4 5.6-9.1 127 7.2 5.5-8.9

18-69 753 5.6 4.9-6.3 773 5.5 4.9-6.2

Mean number of drinking occasions for male current drinkers during past 30 days was 5.6 (95%CI 4.9-6.3). Highest mean drinking occasions was seen in the age group of 60-69 years.

5.5. Mean number of drinks

Table 5.5: Mean number of standard drinks per drinking occasion among current (past 30 days) drinkers.

Age Group(years)

Men Both Sexes


18-29 71 4.6 3.7 - 5.6 72 4.6 3.6 - 5.6

30-44 277 4.1 3.6 - 4.6 281 4.1 3.6 - 4.5

45-59 286 4.1 3.7 - 4.6 296 4.1 3.6 - 4.5

60-69 122 5.0 3.5 - 6.4 127 4.9 3.4 - 6.3

18-69 756 4.3 3.9 - 4.7 776 4.3 3.9 - 4.6


Mean number of standard drinks per drinking occasion among current male drinkers during past 30 days were 4.3 (95% CI: 3.9 - 4.7).

5.6. Drinking level in adults

Male drinkers who consumed ≥ 60g of pure alcohol and female drinkers who consumed ≥ 40g of pure alcohol on average per occasion are classified as high-end level drinkers. The survey estimated that 1.2% of the male adults were drinking at the high-end level. Majority of high-end level male drinkers were seen in the age group of 60-69 years. None of the females were in the High-end level drinking category.

Male drinkers who consumed 40.0 - 59.9g of pure alcohol and female drinkers who consumed 20.0 - 39.9g of pure alcohol on average per occasion are classified as Intermediate-end level drinkers. Of the adults, 0.9% of males were estimated to be intermediate level drinkers. None of the females were in this group.

Male drinkers who consumed <40g of pure alcohol and female drinkers who consumed <20g of pure alcohol on average per occasion are classified as lower-end level drinkers. Nearly one thirds (31.6%) of the males and 0.5% of the females of the adults were estimated to be consuming alcohol in lower-end level.

Table 5.6: Distribution of high-end level drinking among drinkers

Age Group(years)

Men Both Sexes

n % ≥60g 95% CI n % high-end level

95% CI

18-29 291 0.4 0.0-1.0 795 0.2 0.0-0.5

30-44 665 1.4 0.3-2.4 1808 0.7 0.2-1.2

45-59 665 1.8 0.6-2.9 1667 0.8 0.3-1.4

60-69 361 2.1 0.5-3.6 863 1.0 0.3-1.8

18-69 1982 1.2 0.6-1.7 5133 0.6 0.3-0.9

Table 5.7: Distribution of intermediate-end level drinking among drinkers

Age Group(years)

Men Both Sexes

n % ≥40-59.9g 95% CI n % intermediate-end level

95% CI

18-29 291 0.5 0.0-1.4 795 0.2 0.0-0.7

30-44 665 1.4 0.4-2.3 1808 0.7 0.2-1.2

45-59 665 0.9 0.1-1.7 1667 0.4 0.0-0.8

60-69 361 1.0 0.1-2.0 863 0.5 0.0-1.0

18-69 1982 0.9 0.4-1.4 5133 0.4 0.2-0.7


Table 5.8: Distribution of lower-end level drinking among drinkers

Age Group(years)


n % <40g 95% CI n % <20g 95% CI n % lower-end level

95% CI

18-29 291 21.8 16.4-27.2 504 0.2 0.0-0.4 795 11.4 8.5-14.4

30-44 665 38.6 34.3-42.9 1143 0.3 0.0-0.5 1808 19.7 17.4-22.0

45-59 665 38.0 33.7-42.3 1002 0.9 0.4-1.5 1667 18.7 16.4-21.0

60-69 361 30.0 24.7-35.3 502 1.0 0.0-2.2 863 15.5 12.6-18.5

18-69 1982 31.6 28.9-34.4 3151 0.5 0.2-0.8 5133 16.2 14.8-17.6

5.7. Drinking level among current drinkers

Great majority (93.9%) of the current male drinkers were estimated to be consuming low end level alcohol and only 3.5% were consuming high end level alcohol. All the current female drinkers consumed alcohol in low end level.

Figure 5.2: Distribution of high-end, intermediate and lower-end level drinking among current (past 30 days) drinkers

5.8. Mean maximum number of drinks consumed

Figure 5.3: Mean maximum number of standard drinks consumed on one occasion in the past 30 days

100

80

60

40

20

00Male Female Both Sexes

% of high-end

% of intermediate-end

% of lower-end

3.5

2.6

93.9

0.0

0.0

100

3.5

2.6

94.0

6

5

4

3

2

1

0Age group

18-29Age group

30-44Age group

45-59Age group

60-69Target

Population

Mea

n m

axim

um n

umbe

r of

sta

ndar

d dr

inks

5.6

2.0

5.6

5.4

1.4

5.3

5.4

5.3

1.4

1.0

5.5

5.4

5.5

1.4

5.4


Perc

enta

ge


Mean maximum number of standard drink consumed during past 30 days among males was 5.5 (4.9-6.0) and for females 1.4. Highest was seen among males in the age group of 18-29 years.

5.9. Binged drinking (six or more drinks per occasion)

It is estimated 16.8% of the males had indulged in heavy episodic or binge drinking (six or more drinks on a single occasion) during last 30 days whereas only 0.1% of the females were estimated to have taken that much of alcohol. Highest prevalence was seen among 45-59 years old males.

25

20

15

10

05

0018-29 30-44 45-59 60-69 18-69

perc

enta

ge

13.1

00.0

6.9

18

21.2

10.4

7.4 8.6

14.716.8

0.1 0.1 0.1 0.1

9.3


Age group

Figure 5.4: Distribution of those who had six or more drinks on a single occasion at least once during past 30 days


6. Diet

6.1. Fruit and vegetable consumption

6.1.1. Mean number of days fruits and vegetables consumed

Figure 6.1: Mean number of days of fruit & vegetable consumption per week

Sri Lanka adults consumed fruits on 3.6 days per week on average (95% CI: 3.5-3.7); 3.5 days for men (95% CI: 3.4-3.6) and 3.8 for women (95% CI: 3.7-3.9). Mean number of days of vegetable consumption in the adults were 6.6 (95% CI: 6.5-6.6); 6.5 for males (95% CI: 6.5-6.6) and 6.6 for females (95% CI: 6.5-6.7).

6.1.2. Mean number of servings of Fruit and vegetable consumed per day

Table 6.1: Mean number of servings of fruit on average per day

Age Group (years)


n Mean No. of

servings

95% CI n Mean No. of servings

95% CI n Mean No. of

servings

95% CI

18-29 287 1.4 1.0-1.7 499 1.3 1.1-1.4 786 1.3 1.1-1.5

30-44 657 1.3 1.1-1.4 1128 1.3 1.2-1.4 1785 1.3 1.2-1.4

45-59 665 1.3 1.1-1.4 982 1.3 1.2-1.5 1647 1.3 1.2-1.4

60-69 356 1.4 1.2-1.6 487 1.2 1.1-1.3 843 1.3 1.2-1.5

18-69 1965 1.3 1.2-1.5 3096 1.3 1.2-1.4 5061 1.3 1.2-1.4

7

6

5

4

3

2

1

0


Mea

n no

of

days

Fruit

Vegitable

3.5

6.5

3.8

6.6

3.6

6.6


Table 6.2: Mean number of servings of vegetables consumed on average per day

Age Group (years)


n Mean No. of

servings


servings


servings

95% CI

18-29 292 2.9 2.5-3.3 502 3.4 3.0-3.7 794 3.1 2.8-3.4

30-44 670 3.0 2.8-3.3 1139 3.2 2.9-3.4 1809 3.1 2.9-3.3

45-59 678 3.1 2.8-3.3 992 2.8 2.6-3.1 1670 3.0 2.8-3.2

60-69 358 2.9 2.6-3.2 492 2.8 2.6-3.0 850 2.9 2.7-3.1

18-69 1998 3.0 2.8-3.2 3125 3.1 2.9-3.3 5123 3.0 2.8-3.2

Mean number of servings of fruits consumed by both males and females per day was estimated to be 1.3 servings. Mean number of servings of vegetables consumed by males was 3.0 (95% CI: 2.8-3.2) and for females was 3.1 (95% CI: 2.9-3.3).

6.1.3. Mean number of servings of fruits and or vegetables

It is estimated that Sri Lanka males consumed 4.3 (95% CI: 4.0-4.6) servings of fruits and/or vegetables per day on average while females consumed 4.4 (95% CI: 4.1-4.7) servings of fruits and/or vegetables per day. Mean servings of fruits and/or vegetables consumed by both sexes were similar.

6.1.4. Number of servings of fruits and vegetables

According to the findings of the STEPS survey, only 27% of the males and 28% of the females were consuming five or more servings of fruits and/or vegetables per day which is the daily recommended amount by the WHO. Majority of the males (37.3%) were consuming 1-2 servings of fruits and/or vegetables per day and majority of females (35.8%) were consuming 3-4 servings of fruits and/or vegetables per day. Nearly 2% of males as well as females reported consuming neither fruits nor vegetables.

18-29

4.4

4.5

4.6

4.7

4.3

4.2

4.1

4

3.9

3.8

3.730-44 45-59 60-69 18-69

Mea

n no

of

serv

ings

4.2

4.6

4.4

4.3

4.5

4.4

4.3

4.1

Age Group

Figure 6.2: Mean number of servings of fruit and/or vegetables consumed on average per day

4.2

4.3

4

4.2

4.3

4.4

4.3

Men WomenBoth Sexes


Figure 6.3: Distribution by number of servings of fruit and/or vegetables consumed on average per day

Table 6.3: Distribution by those who consumed less than 5 servings of fruits and/or vegetables per day

Age Group (years)


n % Current users



95% CI

18-29 292 75.2 69.0-81.5 504 70.0 64.5-75.4 796 72.7 68.0-77.5

30-44 671 73.9 69.6-78.3 1141 71.3 67.7-74.9 1812 72.6 69.3-75.9

45-59 681 70.8 66.5-75.2 996 74.3 70.6-78.1 1677 72.6 69.4-75.9

60-69 360 69.2 63.7-74.7 494 73.9 69.4-78.5 854 71.5 67.5-75.6

18-69 2004 73.1 69.7-76.5 3135 72.0 68.8-75.1 5139 72.5 69.7-75.4

6.2. Salt

Various sources of dietary salt were assessed in this survey. More than half of the target households (52.8%) reported adding salt to rice while cooking.

Table 6.4: Distribution by those who add salt always or often when cooking rice at home

Age Group (years)


n % 95% CI n % 95% CI n % 95% CI

18-29 265 56.2 49.1-63.2 502 52.3 46.8-57.8 767 54.2 49.3-59.1

30-44 651 55.0 50.2-59.8 1142 55.8 52.2-59.5 1793 55.4 52.0-58.8

45-59 665 52.9 48.0-57.7 1002 50.6 46.6-54.5 1667 51.7 48.3-55.0

60-69 351 42.7 36.7-48.7 502 45.9 40.3-51.5 853 44.3 40.0-48.7

18-69 1932 53.5 49.8-57.1 3148 52.2 49.2-55.1 5080 52.8 50.0-55.7

40

35

30

25

20

15

10

05

00No fruitand/or

Vegitables

1-2 Servings 3-4 Servings ≥5 Servings

Perc

enta

ge

2.21.7 1.9

37.3

34.5

35.9

33.6

35.834.7

26.928.0 17.5

MenWomenBoth Sexes


6.2.1. Process food consumption pattern

Table 6.5: Always or often eat processed foods high in salt

Age Group (years)


n % Current users



95% CI

18-29 291 34.1 27.6-40.6 502 25.6 20.8-30.5 793 30.1 25.6-34.5

30-44 671 26.5 22.2-30.8 1143 24.9 21.3-28.6 1814 25.7 22.5-28.9

45-59 679 24.3 20.3-28.3 999 23.7 20.3-27.2 1678 24.0 21.1-26.9

60-69 363 24.3 18.8-29.7 499 24.3 19.4-29.3 862 24.3 20.2-28.4

18-69 2004 28.3 25.0-31.7 3143 24.8 21.9-27.6 5147 26.6 23.9-29.3

Approximately 27% of the adults (28.3% males and 24.8% females) were estimated to always or often eat processed food.

It is estimated that 23% of the adults limited the consumption of processed food as a specific action taken on a regular basis to control salt intake. Only 6% reported that they looked at the salt or sodium content in the food labels, and only 3% stated that they buy low salt or sodium alternative. About 15% of the adults (13.7% males and 16.7% females avoided eating food cooked outside of a home. Nearly 19% of them (15.8% male and 21.2% females) avoided adding salt while cooking rice (Annexure 2.1).

6.2.2. Meals eaten outside a home

Table 6.6: Mean number of meals eaten outside home

Age Group


n mean 95% CI n mean 95% CI n mean 95% CI

18-29 290 2.7 2.1-3.3 500 1.1 0.8-1.4 788 1.9 1.6-2.3

30-44 672 2.4 2.0-2.7 1140 0.7 0.6-0.9 1813 1.6 1.4-1.8

45-59 674 1.5 1.1-1.7 993 0.6 0.4-0.8 1666 1.0 0.8-1.2

60-69 356 0.9 0.6-1.1 496 0.5 0.3-0.7 851 0.6 0.5-0.8

18-69 1991 2.1 1.8-2.4 3129 0.8 0.6-0.9 5118 1.4 1.3-1.6

On average, males consumed two meals per week which were not prepared at a home.


7. Physical Activity

WHO has recommended following level physical activity to maintain a healthy life. The recommendations are as follows:

Throughout a week, including activity for work, during transport and leisure time, adults should do at least •150minutesofmoderate-intensityphysicalactivityOR •75minutesofvigorous-intensityphysicalactivityORAn equivalent combination of moderate- and vigorous-intensity physical activity achieving at least 600 MET-minutes

Participants were assessed on whether they met the WHO recommended level of physical activity during activity at work or travel to and from places or as a recreational activity.

7.1. Physically inactive

Table 7.1: Distribution of those who are physically inactive by sex and age groups

Age Group (years)


n % not meeting

recs

95% CI n % not meeting

recs

95% CI n % not meeting

recs

95% CI

18-29 289 21.6 15.7-27.5 503 43.4 38.0-48.9 792 32.1 27.8-36.4

30-44 660 22.4 18.5-26.3 1133 33.3 29.7-36.9 1793 27.8 24.8-30.8

45-59 675 22.1 18.2-25.9 989 34.9 31.1-38.8 1664 28.7 25.7-31.7

60-69 361 26.3 21.0-31.5 496 45.8 40.2-51.4 857 36.0 31.7-40.3

18-69 1985 22.5 19.4-25.6 3121 38.4 35.5-41.4 5106 30.4 27.9-32.8

It is estimated that 22.5% of the males and 38.4% of the females in Sri Lanka did not meet the WHO recommendation of physical activity. Physical inactivity was more among females than males with higher prevalence among the age groups 60- 69 years and 18- 29 years.

7.2. Level of physical activity

Table 7.2: Distribution of level of total physical activity of males according to WHO recommendations

Men

Age Group(years) n % Low 95% CI % Moderate 95% CI % High 95% CI

18-29 289 25.5 19.5-31.5 23.0 17.6-28.4 51.5 45.2-57.9

30-44 660 29.2 25.1-33.4 17.8 14.6-21.0 53.0 48.4-57.6

45-59 675 28.9 24.9-32.9 12.9 10.3-15.6 58.2 53.7-62.6

60-69 361 31.7 26.3-37.1 16.4 12.2-20.6 51.9 45.9-57.8

18-69 1985 28.1 25.0-31.2 18.2 16.0-20.5 53.7 50.5-56.9


Table 7.3: Distribution of level of total physical activity of females according to WHO recommendations

Women

Age Group(years) n % Low 95% CI % Moderate 95% CI % High 95% CI

18-29 503 49.2 43.8-54.5 25.7 21.5-29.9 25.0 20.8-29.3

30-44 1133 38.7 35.0-42.4 23.8 20.8-26.8 37.5 33.5-41.5

45-59 989 40.8 36.9-44.7 22.8 19.8-25.9 36.4 32.4-40.3

60-69 496 52.0 46.4-57.6 18.7 14.6-22.8 29.3 24.4-34.1

18-69 3121 44.2 41.2-47.1 23.6 21.6-25.7 32.2 29.3-35.1

Table 7.4: Distribution of level of total physical activity of both sexes according to WHO recommendations

Both sexes

Age Group (years) n % Low 95% CI % Moderate 95% CI % High 95% CI

18-29 792 36.9 32.7-41.0 24.3 20.8-27.8 38.8 34.7-42.9

30-44 1793 33.9 30.8-37.0 20.7 18.5-23.0 45.3 42.0-48.7

45-59 1664 35.0 32.0-38.0 18.0 15.9-20.1 47.0 43.7-50.2

60-69 857 41.8 37.4-46.1 17.6 14.5-20.7 40.6 36.5-44.8

18-69 5106 36.0 33.6-38.5 20.9 19.3-22.5 43.1 40.6-45.5

More than half of the males (53.7%) were engaged in high intensity physical activity. However, only 32.2% of the females were engaging in high intensity physical activity. Majority of females (44.2%) were engaged in low intensity physical activity and 28.1% of the males were also engaged in low level of physical activity.

7.3. Time spent on physical activity

It is estimated that mean time engaged in physical activity per day for adults was 153.9 minutes (95% CI: 143.4-164.3). Mean time spent on physical activity among females was lowest in the age group 18-29 years.

Table 7.5: Mean minutes of total physical activity per day

Age Group (years)


n Mean minutes

95% CI n Mean minutes


95% CI

18-29 289 187.7 159.8-215.6 503 74.2 63.4-85.0 792 133.2 116.7-149.7

30-44 660 208.1 188.2-228.0 1133 122.2 109.2-135.2 1793 165.7 152.5-178.9

45-59 675 225.2 204.7-245.8 989 126.3 113.2-139.4 1664 174.5 160.8-188.1

60-69 361 180.5 156.2-204.8 496 92.6 79.3-105.9 857 136.9 121.5-152.3

18-69 1985 202.4 187.0-217.7 3121 104.3 95.6-113.0 5106 153.9 143.4-164.3


Table 7.6: Median minutes of total physical activity per day

Age Group (years)


n Median min-utes

Inter-quar-tile range

n Median minutes

Inter-quar-tile range

n Median minutes

Inter-quartile range

18-29 289 107.1 21.4-291.4 502 25.7 1.4-110.0 791 60.0 8.6-188.6

30-44 660 128.6 25.7-360.0 1134 60.0 8.6-180.0 1794 85.7 14.3-277.1

45-59 675 171.4 30.0-383.6 989 60.0 8.6-180.0 1664 100.0 14.3-282.9

60-69 361 120.0 17.1-291.4 496 32.1 0.0-137.1 857 68.6 4.3-214.3

18-69 1985 124.3 25.7-336.4 3121 42.8 4.3-150.0 5106 77.1 12.8-240.0

Median number of minutes engaged in physical activity on average per day for the adults was 77.1 (95% CI: 12.8-240.0). The median number of minutes for males was more than the females (124.2 for males and 42.8 for females).

Mean number minutes of work related physical activity for the adults was estimated to be 117.7 with a higher mean for males (153.7) than females (80.8) (Annexure 3.1). Mean number of minutes of transport related physical activity on average per is 28.6 with males having higher figure (36.1) than females (21.0) (Annexure 3.1). Mean number of minutes on recreational related physical activity was 7.6 with females showing low figure (12.6 for males and 2.4 for females) (Annexure 3.1).


7.4. Physical activity at work and during transport

Figures 7.1 and 7.2 show the estimated prevalence of physical inactivity in the adults, while at work or during transport. Nearly 34% of males and 45% of the females were estimated to be not getting recommended physical activity during work. In 43% of the males and 46% of the females, transport mechanism didn’t include any physical activity.

Figure 7.1: Distribution by work related physical inactivity

Figure 7.2: Distribution by transport related physical inactivity

7.5. Recreation related physical activity

Percentage of the adults who are estimated to be not engaged in recreation related physical activities are shown in Figure 7.3.

Figure 7.3: Distribution by recreation related physical activity

18-29

60

50

40

30

20

10

0030-44 45-59 60-69 18-69

40.1

53.7

46.6

29.8

39.4

34.6 27

.1

39.1

33.3

37.6 49

.5 43.5

33.6

45.1

39.3

Men

Women

Both Sexes

Perc

enta

ge

Age Group

18-29

60

50

40

30

20

10

0030-44 45-59 60-69 18-69

44.7 46

.3

45.5

45.9

45.0

45.5

40.9 44

.4

42.7

36.8

49.4

43.0

43.2

45.8

44.5

Men

Women

Both Sexes

Perc

enta

ge

Age Group

18-29

120

100

80

60

40

20

0030-44 45-59 60-69 18-69

61.1

90.6

75.3 83

.6 94.8

89.1

93.3

96.3

94.8 93

.2 97.2

95.2

79.3

94.8

86.6

Men

Women

Both Sexes

Perc

enta

ge

Age Group


Most of the adults (86.6%) were estimated to be not engaged in recreation related physical activities, including 94.1% females and 79.3% males.

Major contribution (61.5%) for the physical activity was from activities carried out at work (63.7% for males and 59.2% for females), while travelling accounted for 30.6% of the total physical activity in the adults (25.1% for males and 36.8% for females) (Annexure 3.2).

Table 7.5: Distribution of those not meeting WHO recommendations on vigorous physical activity for health

Age Group (years)


n % no vigorous activity

95% CI n % no vigorous activity

95% CI n % no vigorous activity

95% CI

18-29 289 56.2 15.7-27.5 503 91.3 88.4-94.1 792 73.0 69.0-77.0

30-44 660 57.5 18.5-26.3 1133 86.1 83.4-88.7 1793 71.6 68.7-74.5

45-59 675 56.7 18.2-25.9 989 88.3 85.7-90.8 1664 72.9 70.2-75.6

60-69 361 71.5 21.0-31.5 496 93.4 91.2-95.7 857 82.4 79.3-85.5

18-69 1985 58.3 19.4-25.6 3121 89.2 87.5-90.8 5106 73.6 71.6-75.6

Of the adults, 73.6% were estimated to be not engaged in the vigorous physical activity. Majority of females (89.2%) and males (58.3%) fell in to this category.

Mean number of minutes spent in sedentary activities for males was 217.9 and median number of minutes engaged in sedentary activities for males was 180.0. Mean number of minutes spent in sedentary activities for females was 214.1 and median number of minutes engaged in sedentary activities for females was 180.0 (Annexure 3.3).



8. History of Raised Blood Pressure

Practices related to checking blood pressure and history of blood pressure was assessed in this survey. One third of the adults (30.7%) had never had their blood pressure checked. Of all adults, 8.1% (6.0% for males and 10.3% for females) were estimated to be detected with high blood pressure during last year. Higher prevalence was seen among the older age groups with the highest prevalence among the age group of 60 – 69 years (Annexure 4.1).

Table 8.1: Distribution of those currently taking medication for raised blood pressure

Age Group (years)


n % taking meds

95% CI n % taking meds


95% CI

18-29 3 70.3 19.9-100.0 16 0.0 0.0-0.0 19 13.1 0.0-36.7

30-44 43 37.0 22.5-51.5 123 29.4 20.6-38.3 166 32.1 24.5-39.6

45-59 105 63.1 53.1-73.2 248 60.4 53.6-67.1 353 61.4 56.1-66.8

60-69 91 75.4 65.3-85.6 213 79.2 72.9-85.6 304 77.8 72.2-83.5

18-69 242 62.3 55.2-69.3 600 55.1 50.3-59.9 842 57.7 53.8-61.6

As seen in table 8.1, it is estimated that only 57.7% of the adults with raised blood pressure were on medication (62.3% for males and 55.1% for females). More Individuals in the older age groups in both sexes were on medication than those in the younger age groups.

Of all adults, 5.7% adults (7.4% of the males and 4.7% of the females) were estimated to be seeing traditional healers for the treatment of high blood pressure, while 4.0% of the adults were taking traditional medicine. Higher proportion of males (6.6%) were on traditional medicine than of females (2.5%) (Annexure 4.2).



9. History of Diabetes

Practices related to detection of Diabetes and history of high blood sugar was assessed in the participants.

Table 9.1: Distribution of the males by self-reported high blood sugar levels

Men

Age Group(years)

n % Never mea-sured

95% CI % measured, found not

high

95% CI % found high,

but not within past 12 months

95% CI % found high

within past 12 months

95% CI

18-29 293 71.6 65.5-77.6 26.6 20.5-32.6 1.1 0.0-2.3 0.8 0.0-1.9

30-44 674 61.5 57.2-65.7 31.5 27.5-35.4 1.5 0.4-2.5 5.6 3.6-7.6

45-59 686 47.1 42.5-51.6 36.9 32.7-41.2 2.2 1.1-3.2 13.9 11.1-16.6

60-69 364 34.2 28.4-39.9 48.6 42.8-54.4 5.1 2.6-7.6 12.2 8.4-15.9

18-69 2017 58.4 55.2-61.6 33.0 29.9-36.0 1.9 1.3-2.5 6.7 5.6-7.9

Table 9.2: Distribution of the females by self-reported high blood sugar levels

Age Group(years)

Women

n % Never measured


high

95% CI % found high, but

not within past 12 months

95% CI % found high

within past 12 month

95% CI

18-29 504 61.6 56.3-66.9 37.1 31.9-42.2 1.1 0.2-2.0 0.2 0.0-0.6

30-44 1142 36.3 32.5-40.0 56.6 52.8-60.4 2.1 1.1-3.1 5.1 3.6-6.5

45-59 1000 34.0 30.3-37.6 50.3 46.4-54.2 1.7 0.8-2.7 14.0 11.7-16.3

60-69 502 28.9 24.0-33.9 45.5 40.1-50.9 3.1 1.4-4.8 22.4 18.3-26.6

18-69 3148 43.1 40.2-46.1 47.3 44.5-50.1 1.8 1.2-2.3 7.8 6.8-8.8

Nearly 7% of the adults (6.7% for males and 7.8% for females) who have had their blood sugar levels checked during last 12 months had found it to be raised.

Table 9.3: Distribution of the both sexes by self-reported high blood sugar levels

Both Sexes

Age Group(years)

n % Never measured


high

95% CI % found high, but

not in past 12 months

95% CI % found high in past 12 months

95% CI

18-29 797 66.8 62.5-71.1 31.6 27.3-35.9 1.1 0.3-1.8 0.5 0.0-1.1

30-44 1816 49.1 46.0-52.3 43.8 40.8-46.7 1.8 1.0-2.5 5.3 4.1-6.6

45-59 1686 40.4 37.2-43.5 43.8 40.7-46.9 1.9 1.2-2.7 14.0 12.1-15.8

60-69 866 31.6 27.5-35.6 47.1 42.9-51.2 4.1 2.6-5.6 17.3 14.5-20.1

18-69 5165 50.9 48.4-53.4 40.0 37.7-42.3 1.8 1.4-2.3 7.3 6.5-8.0


Out of the adults with self-reported high blood sugar, 69.5% (65.7% for males and 73.1% for females) were estimated to be taking medicine for raised blood sugar (Table 9.4). More individuals in older age groups were on treatment than the younger age groups among both sexes.

Table 9.4: Distribution of those currently taking drugs (medication) prescribed for diabetes among those previ-ously diagnosed

Age Group(years)


n % taking meds



95% CI

18-29 5 24.2 0.0-64.6 7 16.2 0.0-45.2 12 21.1 0.0-48.9

30-44 45 63.5 49.2-77.8 77 52.4 39.6-65.2 122 58.0 48.3-67.7

45-59 104 69.0 58.6-79.4 161 78.0 70.6-85.5 265 73.6 67.2-79.9

60-69 62 75.7 64.2-87.3 129 89.5 83.3-95.6 191 83.9 77.5-90.3

18-69 216 65.7 58.0-73.5 374 73.1 67.9-78.2 590 69.5 65.0-74.1

Among those previously diagnosed as having high blood sugar, 12.3% were on insulin (13.5% for males and 11.3 % for females).

Table 9.5: Distribution of those currently on insulin for diabetes among those previously diagnosed

Age Group(years)


n % taking insulin

95% CI n % taking insulin

95% CI n % taking insulin

95% CI

18-29 5 24.2 0.0-64.6 7 16.2 0.0-45.2 12 21.1 0.0-48.9

30-44 45 1.7 0.0-5.1 77 9.6 2.6-16.7 122 5.6 1.7-9.5

45-59 104 15.7 8.4-22.9 161 8.8 3.8-13.7 265 12.2 7.6-16.7

60-69 62 18.0 7.4-28.6 129 15.6 8.0-23.2 191 16.6 10.0-23.1

18-69 216 13.5 8.2-18.7 374 11.3 7.5-15.0 590 12.3 8.9-15.7

Among the previously diagnosed as having high blood sugar, 9.5% were estimated as seeing traditional healers for treatment (11.1% for males and 8.1% for females) (Annexure 5.1).


10. Total Blood Cholesterol

Self-reported prevalence of high blood cholesterol is described in this section. It is estimated that 71.1% of the adults had never checked their blood cholesterol levels. Out of the adults who have had their blood cholesterol checked, 70.1% (72.7% for males and 67.6% for females) were estimated to be having normal cholesterol levels.

As seen below, 7.2% of males and 10.2% females were estimated to be diagnosed as having high total cholesterol levels (see also Annexure 6.1).

Figure 10.1: Distribution by history of total blood cholesterol measurements

Table 10.1: Distribution of population with high total cholesterol by the status of medication

Age Group


n % taking meds



95% CI

18-29 4 12.3 0.0-36.9 4 0.0 0.0-0.0 8 5.6 0.0-16.6

30-44 50 40.5 26.4-54.6 77 40.3 28.6-52.1 127 40.4 30.8-50.0

45-59 81 50.9 38.6-63.2 194 64.5 57.4-71.6 275 59.4 52.9-65.9

60-69 56 73.0 60.1-85.8 125 77.9 69.8-86.0 181 75.9 68.6-83.2

18-69 191 51.5 43.5-59.6 400 60.7 54.9-66.5 591 56.8 51.9-61.8

As seen in Table 10.1, nearly 57% diagnosed as having high total cholesterol levels were on medication for their condition. Proportion of females who were on treatment (60.7%) was more than the males (51.5%). In both sexes, more people in older age groups were taking treatment than the people in the younger age groups.

Similar proportions of males and females were estimated to be seeing traditional healer for the treatment of high cholesterol levels (9.0% males and 8.7% females) (Annexure 6.2).

100

90

80

70

60

50

40

30

20

10

00Men Women Both Sexes

Perc

enta

ge

76.3

19.2

2.5

4.7 7.6

2.6

21.3

68.5

6.12.5

20.2

71.1

% found high within past 12 months.

% found high but not within past 12 months.

%measured, but not found high.

% never measured.



11. History of Cardiovascular Diseases

Nearly equal proportion of males and females (4.5% of males and 4.2% of females) had a history of a heart attack or chest pain from heart disease. Table 11.1: Distribution of those who ever had a heart attack or chest pain

Age Group


n % CVD history

95% CI n % CVD history

95% CI n % CVD history

95% CI

18-29 293 1.5 0.0-2.9 504 1.5 0.5-2.5 797 1.5 0.6-2.4

30-44 675 2.8 1.4-4.2 1142 3.1 2.0-4.2 1817 2.9 2.0-3.9

45-59 686 6.6 4.3-8.8 1000 6.2 4.4-8.1 1686 6.4 4.9-7.9

60-69 364 14.6 10.5-18.7 502 9.8 7.0-12.6 866 12.2 9.8-14.6

18-69 2018 4.5 3.5-5.6 3148 4.2 3.4-5.0 5166 4.4 3.7-5.1

Higher prevalence of cardiovascular diseases was observed with progression of age in the target population as expected, and the highest prevalence was observed in the age group of 60-69 years, with predominance in males (14.6%) over females (9.8%). Table 11.2: Distribution of population taking aspirin regularly to prevent or treat heart disease


Age Group

n % taking aspirin

95% CI n % taking aspirin

95% CI n % taking aspirin

95% CI

18-29 293 0.3 0.0-0.7 504 0.3 0.0-0.8 797 0.3 0.0-0.7

30-44 675 1.0 0.3-1.8 1142 0.6 0.2-1.0 1817 0.8 0.4-1.2

45-59 686 4.5 2.5-6.4 1000 4.9 3.5-6.3 1686 4.7 3.5-5.9

60-69 364 11.9 8.2-15.7 502 10.5 7.4-13.5 866 11.2 8.7-13.7

18-69 2018 2.8 2.1-3.5 3147 2.8 2.2-3.3 5166 2.8 2.3-3.2

Table 11.3: Distribution of population taking statins regularly to prevent or treat heart disease


Age Group

n % taking statins

95% CI n % taking statins

95% CI n % taking statins

95% CI

18-29 293 0.3 0.0-0.7 504 0.2 0.0-0.6 797 0.3 0.0-0.6

30-44 675 2.3 1.2-3.4 1142 2.5 1.5-3.6 1817 2.4 1.7-3.2

45-59 686 7.4 4.9-9.8 1000 10.0 7.8-12.3 1686 8.7 7.0-10.4

60-69 364 18.3 13.9-22.8 502 19.6 15.6-23.7 866 19.0 15.9-22.0

18-69 2018 4.6 3.7-5.5 3148 5.7 4.7-6.6 5166 5.1 4.4-5.8

Only 2.8% of the target population was on aspirin regularly to prevent or treat cardiovascular disease and this was similar for both sexes.



12. Life Style Advice

Tables 12.1 to 12.4, present the estimated proportions of target population receiving life style advice from a doctor or health worker on major NCD risk factors.

It is estimated that of the total population; 18.7% were advised by a doctor or a health care worker to quit using tobacco or not to initiate. More than one fifths of the total population were advised to reduce salt in the diet. Nearly one third of the population were advised to eat at least 5 servings of fruits and or vegetables daily. More than one third of the target population (36.3%) were advised to reduce fat in their diet.

Table 12.1: Distribution of population advised to quit using tobacco or don’t start


Age Group (years)

n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 21.5 16.0-27.0 504 8.2 5.0-11.4 797 15.1 11.4-18.9

30-44 675 26.5 22.3-30.7 1142 10.0 7.3-12.7 1817 18.4 15.6-21.2

45-59 686 33.8 29.3-38.4 1000 10.5 7.7-13.3 1686 21.9 19.0-24.8

60-69 364 36.2 30.4-41.9 502 9.2 5.8-12.6 866 22.8 19.0-26.5

18-69 2018 27.7 24.6-30.8 3148 9.5 7.2-11.7 5166 18.7 16.4-21.0

Table 12.2: Distribution of population advised to reduce salt in the diet


Age Group (years)

n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 10.0 6.0-13.9 504 19.3 15.2-23.4 797 14.4 11.3-17.5

30-44 675 18.0 14.5-21.5 1142 25.6 22.2-29.0 1817 21.7 19.1-24.3

45-59 686 27.6 23.5-31.7 1000 33.6 29.9-37.4 1686 30.7 27.6-33.7

60-69 364 27.9 22.6-33.2 502 34.8 29.6-40.0 866 31.3 27.5-35.2

18-69 2018 18.7 16.2-21.2 3148 26.7 24.2-29.2 5166 22.6 20.5-24.8

Table 12.3: Distribution of population advised to eat at least five servings of fruit and/or vegetables each day


Age Group (years)

n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 23.0 16.9-29.1 504 36.7 31.4-42.0 797 29.5 25.3-33.8

30-44 675 23.3 19.4-27.1 1142 38.3 34.5-42.0 1817 30.6 27.7-33.6

45-59 686 31.9 27.7-36.0 1000 37.2 33.3-41.0 1686 34.6 31.5-37.7

60-69 364 31.4 25.8-37.0 502 34.2 29.2-39.2 866 32.8 28.9-36.8

18-69 2018 26.2 23.0-29.4 3148 37.0 34.1-39.9 5166 31.5 29.0-34.0


Table 12.4: Distribution of population advised to reduce fat in the diet

Age Group (years)


n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 24.3 18.5-30.1 504 30.8 25.7-36.0 797 27.4 23.2-31.6

30-44 675 32.4 28.2-36.6 1142 42.3 38.5-46.2 1817 37.2 34.0-40.4

45-59 686 39.2 34.8-43.6 1000 49.2 45.3-53.0 1686 44.3 41.1-47.5

60-69 364 42.4 36.7-48.0 502 42.3 36.9-47.7 866 42.3 38.1-46.5

18-69 2018 32.4 29.1-35.6 3148 40.4 37.5-43.3 5166 36.3 33.7-38.9

Table 12.5: Distribution of population advised to start or do more physical activity

Age Group (years)


n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 23.3 17.5-29.2 504 25.1 20.2-30.0 797 24.2 20.0-28.4

30-44 675 25.0 20.9-29.1 1142 32.0 28.2-35.7 1817 28.4 25.3-31.5

45-59 686 29.2 25.1-33.2 1000 32.8 29.0-36.5 1686 31.0 28.0-34.0

60-69 364 31.7 25.9-37.6 502 31.0 26.0-36.0 866 31.4 27.1-35.7

18-69 2018 26.2 23.1-29.3 3148 29.8 27.0-32.6 5166 28.0 25.4-30.5

Table 12.6: Distribution of population advised to maintain a healthy body weight or to lose weight

Age Group (years)


n % advised

95% CI n % advised

95% CI n % advised

95% CI

18-29 293 18.8 13.0-24.6 504 26.5 21.5-31.5 797 22.5 18.2-26.7

30-44 675 23.0 19.1-26.9 1142 36.1 32.2-39.9 1817 29.4 26.3-32.5

45-59 686 24.5 20.4-28.6 1000 34.7 30.7-38.6 1686 29.7 26.5-32.9

60-69 364 25.5 20.1-31.0 502 28.1 23.3-33.0 866 26.8 22.8-30.9

18-69 2018 22.2 19.1-25.3 3148 31.7 28.9-34.5 5166 26.9 24.3-29.4

More than one fourth (28%) of the target population were advised to start or do more physical activity (26.2% of males and 29.8% females). One third (30%) of the target population were advised to maintain a healthy body weight or to lose weight. More females (31.7%) received the advice than the males (22.2%).


13. Cervical Cancer Screening

All the female participants were asked whether they had ever undergone cervical screening. Coverage of cervical screening in the in the females was only 15.2%. Further the coverage was only 14.9% and 22.0% for the age groups of 60-69 years and 45- 59 years, respectively.

Table 13.1: Distribution of females who have ever had a cervical cancer screening test

Women

Age Group (years) n % ever tested 95% CI

18-29 467 1.8 0.3-3.4

30-44 1069 24.1 21.1-27.1

45-59 907 22.0 18.7-25.2

60-69 430 14.9 10.7-19.0

18-69 2873 15.2 13.5-16.9

Women

Age Group (years) n % ever tested 95% CI

30-49 1408 24.5 21.8-27.3

Table 13.2: Distribution of females in the age group of 30-49 who have ever had a cervical cancer screening test

Coverage of cervical screening in the high risk age group of 30-49 years was only 24.5%.



14. Physical Measurements

14.1. Blood pressure measurements

Table 14.1: Mean systolic blood pressure in mmHg

Age Group(years)


n Mean 95% CI n Mean 95% CI n Mean 95% CI

18-29 262 122.1 120.6-123.6 470 113.2 111.7-114.6 732 117.8 116.7-118.9

30-44 617 124.8 123.5-126.0 1065 119.8 118.8-120.9 1682 122.4 121.5-123.2

45-59 640 131.3 129.6-133.0 948 131.3 129.7-132.8 1588 131.3 130.1-132.4

60-69 338 137.0 134.3-139.7 470 144.0 141.4-146.5 808 140.4 138.5-142.3

18-69 1857 126.8 125.9-127.7 2953 123.4 122.4-124.4 4810 125.1 124.4-125.8

Table 14.2: Mean diastolic blood pressure in mmHg

Age Group(years)



18-29 262 77.3 76.1-78.5 470 75.1 73.9-76.3 732 76.3 75.4-77.1

30-44 617 80.5 79.5-81.4 1065 79.9 79.1-80.7 1682 80.2 79.6-80.8

45-59 640 83.7 82.7-84.7 948 84.8 83.9-85.7 1588 84.3 83.6-85.0

60-69 338 83.3 81.7-84.9 470 87.0 85.7-88.2 808 85.1 84.1-86.1

18-69 1857 80.5 79.8-81.1 2953 80.4 79.8-81.1 4810 80.5 80.0-81.0

Mean systolic blood pressure of the target population was estimated to be 125.1 mmHg (95% CI: 124.4-125.8) with a mean of 126.8mmHg (95% CI: 125.9-127.7) in males, and 123.4mmHg (95% CI: 122.4-124.4) in females. Mean diastolic pressure was estimated to be 80.5 (95% CI: 80.0-81.0) mmHg for adults, and there was no significant difference between males and females (in males 80.5 mmHg (95% CI: 79.8-81.1) and in females 80.4 mmHg (95% CI: 79.8-81.1).


Table 14.3: Prevalence of raised blood pressure excluding those on medication for raised blood pressure

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 262 10.0 6.1-13.9 468 8.4 5.6-11.3 730 9.2 6.7-11.8

30-44 598 20.8 17.2-24.3 1034 14.4 12.1-16.7 1632 17.7 15.5-19.9

45-59 592 34.7 30.3-39.1 828 32.8 29.2-36.4 1420 33.8 30.8-36.7

60-69 279 37.6 30.9-44.3 333 51.9 45.7-58.1 612 44.0 39.4-48.6

18-69 1731 21.9 19.5-24.2 2663 20.2 18.3-22.0 4394 21.0 19.5-22.6

Blood pressures of participants who were on medication for raised blood pressure and were not on medication was analysed separately. Raised blood pressure was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/ or diastolic blood pressure (DBP) ≥ 90 mmHg. As seen in table 14.1, nearly one fifths of the adults (21%) had raised blood pressure (21.9% among males and 20.2% among females).

Table 14.4: Prevalence of raised blood pressure including those on medication for raised blood pressure

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 262 10.0 6.1-13.9 470 8.8 5.9-11.6 732 9.4 6.9-11.9

30-44 617 22.8 19.2-26.4 1067 17.3 14.8-19.8 1684 20.1 17.8-22.4

45-59 643 40.1 35.7-44.4 954 42.0 38.4-45.6 1597 41.1 38.2-43.9

60-69 338 47.8 41.5-54.0 473 66.4 61.6-71.1 811 57.0 53.0-61.0

18-69 1860 25.4 23.0-27.9 2964 26.7 24.7-28.6 4824 26.1 24.4-27.7

Prevalence of blood pressure in the adults including currently those on medication was 26.1% (25.4 for males and 26.7 for females).

14.2. Mean heart rate

Estimated mean heart rate in the adults was 75.7 beats per minute (for males 72.9 and for females 78.6) (Annexure 7.1).

14.3. Body Mass Index (BMI)

Mean height for males was 165.4 cm and for females was 152.9 cm (Annexure 7.2). Mean weight for males was 61.4 kg and mean weight for females was 54.6 kg (Annexure 7.3).

Mean BMI for men was 22.4 and for females 23.5 (Annexure 7.4).

Table 14.3 and 14.4 shows the distribution of males and females by the BMI value. Table 14.5 shows the distribution of the adults by the BMI value. Only half of the adults (55.4%) had a normal BMI value (between 18.5 -24.9). 58.9% males and 51.6% of females had a normal BMI value (between 18.5 -24.9).


Table 14.5: Distribution of males by BMI classification

Men

Age Group(years)

n % Under-weight <18.5

95% CI % Normal weight

18.5-24.9

95% CI % BMI25.0-29.9

95% CI %Obese≥30.0

95% CI

18-29 257 20.5 15.1-25.8 61.5 55.0-68.0 16.2 11.4-20.9 1.9 0.0-3.8

30-44 625 13.7 10.5-16.8 55.6 51.0-60.2 25.9 22.0-29.8 4.8 3.0-6.7

45-59 640 13.4 10.3-16.4 59.7 55.5-63.8 23.0 19.2-26.7 4.0 2.4-5.6

60-69 337 19.4 14.9-23.9 58.1 52.4-63.9 18.3 13.3-23.4 4.1 2.0-6.3

18-69 1859 16.5 14.1-18.9 58.9 56.0-61.8 21.0 18.7-23.3 3.5 2.5-4.5

Table 14.6: Distribution of females by BMI classification

Men

Age Group(years)



18.5-24.9

95% CI % BMI25.0-29.9

95% CI %Obese≥30.0

95% CI

18-29 438 23.3 18.7-27.9 57.0 51.7-62.4 15.5 12.0-18.9 4.2 2.3-6.2

30-44 1034 9.6 7.7-11.6 51.3 48.1-54.5 29.0 26.1-31.9 10.1 8.0-12.2

45-59 938 8.6 6.7-10.5 46.9 43.1-50.6 33.3 30.0-36.6 11.2 8.9-13.5

60-69 462 13.2 9.9-16.5 49.0 44.1-54.0 29.2 24.4-34.0 8.6 5.7-11.4

18-69 2872 14.1 12.3-15.9 51.6 49.2-53.9 26.0 24.1-27.8 8.4 7.2-9.6

Table 14.7: Distribution of both sexes by BMI classification

Men

Age Group(years)



18.5-24.9

95% CI % BMI25.0-29.9

95% CI %Obese≥30.0

95% CI

18-29 695 21.8 18.1-25.5 59.4 55.2-63.6 15.8 12.7-18.9 3.0 1.6-4.3

30-44 1659 11.7 9.8-13.7 53.5 50.7-56.4 27.4 24.9-29.8 7.3 6.0-8.7

45-59 1578 10.9 9.2-12.7 53.1 50.3-56.0 28.2 25.6-30.9 7.7 6.2-9.1

60-69 799 16.4 13.4-19.4 53.7 49.8-57.5 23.7 20.1-27.2 6.3 4.5-8.1

18-69 4731 15.3 13.7-16.9 55.4 53.5-57.3 23.4 21.9-24.9 5.9 5.1-6.7

Of all adults, 5.9% were obese (3.5% males and 8.4% females), while 15.3% (16.5% males and 14.1% females) were underweight. There were more females who were obese in the age category 45-59 years. Underweight was more prevalent in the age group of 18-29 years in both sexes.


Age Group18-29

1819.7 18.8

30.7

39.1

34.7

27

44.5

35.9

22.5

37.8

16

24.6

34.3

29.335

40

45

50

30

25

20

15

10

05

0030-44 45-59 60-69 18-69

Men

Women

Both Sexes

Perc

enta

ge

Figure 14.1: Distribution by overweight or obesity

Nearly 29% of the adults was estimated to be overweight or obese (95% CI: 27.5-31.1) with 24.6% men and 34.3% females.

14.4. Waist circumference (cm)

Mean waist circumference for the males was 82.3 cm and for females was 82.1 cm.

Table 14.8: Mean waist circumference in men

Age Group(years)

Men Women


18-29 262 79.7 78.1-81.4 446 76.6 75.4-77.7

30-44 621 83.4 82.3-84.6 1041 84.0 83.0-85.0

45-59 641 84.1 82.9-85.2 939 85.7 84.7-86.7

60-69 340 83.7 81.8-85.6 465 84.2 82.6-85.8

18-69 1864 82.3 81.5-83.2 2891 82.1 81.3-82.9


15. Biochemical Measurements

15.1. Blood sugar measurements

Impaired fasting glycaemia was defined as plasma venous value between 110mg/dl and 126mg/dl and raised blood glucose was defined as plasma venous value more than 126mg/dl.

Mean fasting blood sugar for males was 81.9 mg/dl and for females 81.4 mg/dl.

Table 15.1: Mean fasting blood glucose (mg/dl)

Age Group(years)



18-29 230 73.5 69.8-77.2 416 71.8 68.5-75.0 646 72.7 69.9-75.5

30-44 562 81.7 78.4-84.9 983 77.8 75.4-80.2 1545 79.8 77.5-82.1

45-59 584 91.3 86.8-95.8 877 91.1 87.0-95.1 1461 91.2 88.0-94.4

60-69 309 87.8 82.8-92.7 431 95.8 91.2-100.3 740 91.7 88.2-95.3

18-69 1685 81.9 79.6-84.2 2707 81.4 79.3-83.5 4392 81.6 79.8-83.5

Table 15.2: Prevalence of impaired fasting glycaemia

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 230 1.8 0.1-3.5 416 0.7 0.0-1.6 646 1.3 0.3-2.2

30-44 562 3.5 1.8-5.1 983 1.9 0.9-2.8 1545 2.7 1.7-3.6

45-59 584 7.4 4.7-10.1 877 6.3 4.4-8.2 1461 6.8 5.1-8.5

60-69 309 8.0 4.6-11.4 432 6.5 4.1-8.9 741 7.2 5.1-9.3

18-69 1685 4.4 3.2-5.5 2708 3.2 2.4-4.0 4393 3.8 3.1-4.5

Impaired fasting glycaemia was defined as plasma venous value between 110mg/dl and 126mg/dl and raised blood glucose was defined as plasma venous value more than 126mg/dl.

Nearly 4% of the adults were estimated to have impaired fasting glycaemia, with 4.4% males and 3.2% females.

The survey estimated that 7.4% of the adults (7.3% males and 7.6% females) either had raised blood glucose or were currently on medication for diabetes.

Table 15.3: Percentage with raised blood glucose (<126 mg/dl) or currently on medication for diabetes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 230 2.8 0.4-5.2 416 2.2 0.4-3.9 646 2.5 1.0-4.0

30-44 562 6.6 4.3-8.9 983 5.7 3.9-7.4 1545 6.2 4.7-7.6

45-59 584 12.9 9.9-15.8 877 12.0 9.7-14.3 1461 12.4 10.5-14.3

60-69 309 10.6 6.5-14.6 432 18.2 14.2-22.3 741 14.4 11.3-17.4

18-69 1685 7.3 5.9-8.7 2708 7.6 6.4-8.8 4393 7.4 6.4-8.5


Table 15.4: Percentage who are currently on medication for diabetes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 295 0.7 0.0-1.7 508 0.5 0.0-1.2 803 0.6 0.0-1.2

30-44 679 5.1 3.3-6.9 1143 3.9 2.6-5.2 1822 4.5 3.4-5.6

45-59 691 12.0 9.3-14.7 1004 12.8 10.6-15.0 1695 12.4 10.6-14.2

60-69 365 14.1 10.1-18.1 503 23.0 18.8-27.1 868 18.5 15.5-21.4

18-69 2030 6.1 5.0-7.2 3158 7.2 6.3-8.1 5188 6.6 5.9-7.3

It was estimated that 6.6% of the adults (6.1% of males and 7.2% of females) were currently on medication for diabetes. More proportion of people in the age group 60-69 years were on medication for diabetes as expected.

15.2. Cholesterol level

An abnormal lipid profile is known to be a major risk factor for cardiovascular diseases. Total cholesterol was measured by trained health care workers following the standard STEPS 3 protocol, using the validated equipment mentioned in the data collection section. Raised total cholesterol was defined as blood cholesterol levels ≥ 190 mg/dl.

Mean total serum cholesterol level for adults including those on medication was 152.2 mg/dl (males 146.8 mg/dl and females 157.8mg/dl). Highest mean cholesterol level among females was seen in the age group 60-69 years (Annexure 8.1).

Table 15.5: Prevalence with total cholesterol ≥ 190 mg/dl or currently on medication for raised cholesterol

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 235 9.8 5.7-13.8 432 17.4 13.1-21.7 667 13.4 10.4-16.5

30-44 583 19.1 15.2-23.0 1018 22.2 19.1-25.3 1601 20.6 17.9-23.3

45-59 603 26.3 22.0-30.6 909 40.8 36.8-44.7 1512 33.7 30.6-36.8

60-69 321 32.3 26.2-38.4 446 47.3 41.7-52.9 767 39.7 35.2-44.3

18-69 1742 19.1 16.5-21.6 2805 28.4 26.0-30.9 4547 23.7 21.7-25.7

Nearly one fourth of the adults (23.7%) was estimated to have either the total cholesterol ≥190 mg/dl or were currently on medication for raised cholesterol. This proportion was higher for females (28.4%) as compared to males (19.1%). Prevalence of high cholesterol was more in older age groups in both sexes.

Table 15.6 shows the prevalence of total cholesterol ≥ 240 mg/dl or currently on medication for raised cholesterol. Overall, 8.9% of the adults had raised total cholesterol ≥ 240 mg/dl or were currently on medication for raised cholesterol. It was again higher for females (11.3%) than males (6.5%).


Table 15.6: Prevalence with total cholesterol ≥ 240 mg/dl or currently on medication for raised cholesterol

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 235 1.5 0.0-3.3 432 3.8 1.7-5.9 667 2.6 1.2-3.9

30-44 583 5.7 3.7-7.6 1018 6.7 4.8-8.5 1601 6.1 4.7-7.6

45-59 603 9.6 6.9-12.3 909 19.7 16.8-22.6 1512 14.7 12.7-16.8

60-69 321 17.9 12.8-23.0 446 25.8 21.1-30.6 767 21.8 18.1-25.5

18-69 1742 6.5 5.2-7.8 2805 11.3 9.9-12.8 4547 8.9 7.8-9.9



16. Cardiovascular Disease Risk

A 10-year risk of having a cardiovascular (CVD) event of ≥30% is defined according to age, sex, blood pressure, smoking status (current smokers or those who quit smoking less than one year before the assessment), total cholesterol, and diabetes (previously diagnosed or a fasting plasma glucose concentration ≥126 mg/dl) status of the respondents.

The proportion of respondents in the age group 40–69 years with a 10-year CVD risk of ≥30% was 9.1% for both sexes (men 8.9%, women 9.3%). Both among men and women, this proportion was higher for the 55-69 years age group (Table 16.1).

Table 16.1: Prevalence of 10-year CVD risk or existing CVD

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

40-54 574 5.4 3.2-7.5 893 6.7 4.8-8.6 1467 6.0 4.6-7.5

55-69 474 13.7 10.0-17.4 682 13.3 10.5-16.1 1156 13.5 11.2-15.8

40-69 1048 8.9 6.9-10.9 1575 9.3 7.6-11.1 2623 9.1 7.8-10.4

Table 16.2: Percentage of eligible persons receiving drug therapy and counselling to prevent heart attacks and strokes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

40-54 27 38.5 20.2-56.9 59 47.6 34.2-61.0 86 43.6 32.5-54.8

55-69 62 66.2 53.8-78.5 94 60.1 48.6-71.6 156 63.2 54.4-72.1

40-69 89 56.4 45.7-67.2 153 54.7 45.5-64.0 242 55.6 48.2-62.9

Only one in 2 adults (55.6%) who had the 10-year CVD risk of ≥30%, were receiving drug therapy and counselling to prevent heart attacks and strokes.



17. Summary of Combined Risk Factors

For the purpose of exploring combined risk factors, responses were grouped into three categories according to the presence of the five major risk factors based on principal component analysis.

1. The first category was ‘no risk factors’; the second ‘1-2 risk factors’, and the third ‘3-5 risk factors’. The five major risk factors are: Current daily smoking

2. Less than five servings of fruit and/or vegetables per day3. Not meeting WHO recommendations on physical activity for health (<150 minutes of

moderate activity per week, or equivalent)4. Overweight or obese (BMI ≥ 25 kg/m2)5. Raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP).

Majority of the adults (73.5%) was estimated to have 1-2 risk factors (76.0% males and 71.0% females). Those with 1-2 risk factors were more among the age group 18-44 years than 45-69 years in both sexes. Nearly 18% of the adults were estimated to have 3-5 risk factors. 20.2% of the females and 16.4% males had 3-5 risk factors. Prevalence of 3-5 risk factors was more among 45-69 years in both sexes (24% in males and 31.4% in females).

Table 17.1: Distribution by combined risk factors

Combined Risk Factors

Men

Age Group (years)

n % with 0 risk factors

95% CI % with 1-2 risk factors

95% CI % with 3-5 risk factors

95% CI

18-44 834 8.1 5.7-10.5 79.9 76.6-83.1 12.1 9.6-14.5

45-69 927 6.8 4.8-8.9 69.1 65.6-72.7 24.0 20.8-27.2

18-69 1761 7.6 5.9-9.4 76.0 73.5-78.4 16.4 14.3-18.5

Women

18-44 1411 11.5 9.0-14.0 75.5 72.7-78.3 13.0 10.9-15.0

45-69 1344 4.6 3.3-5.8 64.0 61.1-66.9 31.4 28.5-34.3

18-69 2755 8.8 7.1-10.5 71.0 68.9-73.1 20.2 18.4-22.1

Both Sexes

18-44 2245 9.7 7.8-11.6 77.8 75.6-80.0 12.5 10.9-14.1

45-69 2271 5.7 4.4-7.0 66.6 64.3-68.9 27.8 25.5-30.0

18-69 4516 8.2 6.8-9.6 73.5 71.9-75.2 18.3 16.8-19.7



18. Conclusion and Recommendations

Similar to many developing countries, Sri Lanka is undergoing an epidemiological transition with an increasing burden of NCDs. Deaths due to ischaemic heart diseases and stroke rank high among the top causes of the mortality. This kind of NCD burden is likely to be even more problematic in the immediate future, considering the population’s high exposure to commonly known risk factors of NCDs such as tobacco use, excessive alcohol consumption, physical inactivity, unhealthy diet, and high salt consumption.

The 2014-2015 Island wide STEP survey has provided rich information on the prevalence of key NCD risk factors in Sri Lanka, and has revealed high rates of tobacco and alcohol use, inadequate physical activity, unhealthy dietary behaviours, and low levels of health screening for major NCD risk factors. The prevalence of behavioural risk factors (tobacco smoking, alcohol, fruit and vegetable consumption, physical inactivity) show a downward trend when compared with prevalence in 2008.

Although prevalence of current tobacco smoking among males has not been reduced significantly in comparison to the prevalence observed in 2008 (29.4% in 2015 and 29.8% in 2008), prevalence of daily tobacco smoking has been reduced among males (19.9% in 2015 and 22.8% in 2006) and among females (0.1% in 2015 and 0.3% in 2006) indicating a trend in behaviour towards positive direction. This is a clear indication of successful implementation of tobacco control strategies adopted in the country as the prevalence of daily smokers is considered as valid measure of preventive and control activities conducted in a country.

However, approximately one fifths (22.3%) in the younger age group 18-29 are estimated to be current smokers. Mean age for initiation of smoking for male daily smokers was 20.5 years in comparison to the mean age observed in 2006 (27.6). These findings highlight the need for new strategies to strengthen preventive measures to reduce the incidence of smoking among the younger age groups.

As majority of the smokers are smoking manufactured cigarettes, the current strategies to reduce smoking such as pictorial warnings, and other legislative measures should be strengthened.

Current smokeless tobacco use among males is 26.0% and among females 5.3%. The prevalence of smokeless tobacco (daily users of smokeless tobacco) among males is higher (18.9%) than females (4.1%). Prevalence of smoking and smokeless tobacco use among males is 35.3%. This indicate that the there is still a high prevalence of smokeless tobacco usage in our country, warranting more attention towards prevention and control activities focusing on smokeless tobacco use.

Nearly half of the current smokers have tried to stop smoking which highlights the need for properly functioning island-wide tobacco cessation services giving more options to them. It is important to start tobacco cessation facilities including 24 hour tobacco cessation hotline.

Only 35% of the current smokers have been advised by a doctor to stop smoking which is inadequate, and should be intervened. Therefore, it will be useful to have regular training programmes for medical professionals in the country on advising the patients on tobacco cessation and brief interventions.

Around 25% of the male and 22% of females were exposed to second-hand smoke at home, while 36% of males and 11% of females were exposed to second-hand smoke at their work places highlighting the need to strengthen the implementation and enforcement of smoke-free policies.


Hazardous drinking of alcohol in excess of the recommended daily limit is damaging to health. Prevalence of current alcohol use among males has increased in comparison to the prevalence observed in 2008 (34.8% in 2015 and 26.0% in 2008). This is an alarming issue and brings out the need to evaluate the current strategies and policies in view of implementing an accelerated programme while giving more attention to implement “Best Buys”. It is estimated that 16.8% of males adults had indulged in binge drinking (six or more drinks on a single occasion at least once during a month) compared to only 0.1 % of the females. This highlights the need to tailor the current programs to address these critical issues.

Intake of fruits and vegetables plays a protective role in the prevention of cancers, heart diseases and many other diseases. The World Health Organization (WHO) recommends a minimum of five daily servings of fruits and/or vegetables. The survey has estimated that while mean number of days of fruit consumption is 4 and vegetable consumption is 7 in the adults; however only 27.5% of the adults (26.9% of males and 28% of females) consume recommended levels of five or more portions of fruits and or vegetables per week. Although this shows improvement in practices (from the last STEP survey in 2008: males 18.6%, females 16.7%, and adults 17.6%), the amounts consumed is still below the recommended levels. This finding warrants for interventions which would not only improve health literacy, but also economic policy reforms geared towards improving availability and affordability of such food items, and also improving the buying power of the population. Nearly 53% of the population admits to adding salt while cooking rice, 72.5% adding salt while cooking, 21.8% adding salt before or when eating. These practices show a trend in excessive usage of salt in food. Approximately 27% of the population always or often eat processed food high in salt. Furthermore, 61% of the males and 73% of the females knew that consuming too much of sodium could cause serious problems. The identified gap between their knowledge on slat consumption and actual practices of salt consumption should be addressed through properly designed awareness programmes. Findings related to dietary habits indicate the need to carry out appropriate and culturally- tailored programmes to promote healthy diet in the community.

The benefits of physical activity include prevention of heart diseases and diabetes, reduction in obesity, blood pressure and cholesterol, and improvement in mental health conditions. The survey revealed that 22.5% of the males and 38.4% of the females do not meet the minimum WHO recommendations activity (≥150 minutes of moderate intensity physical activity per week, or equivalent), which calls for more awareness programmes on healthy lifestyle, and improve facilities and incentives for engaging in physical activities.

Pattern of lifestyle advice received by the adults from health care providers reflects the current practice where advices on cessation of smoking, consumption of fruits or vegetables are given irrespective of the age of the recipient, while advices on salt and fat reduction from diet is given to older population where the risk of NCD is perceived to be high.

Nutritional problems in both spectrums of overweight and underweight are visible in the population. Of the males, 21% were overweight and 3.5% were obese where as 25.9% of females were overweight and 8.4% of females were obese which shall be given due attention. Meanwhile, 15.3% (16.5% males and 14.1% females) of the population being underweight reveals the fact that under nutrition is still a problem in the country.


The metabolic risk factors for NCDs are raised blood pressure, obesity, raised cholesterol and blood sugar. They will lead to a growing burden of NCDs. The 2014-15 survey estimated that 30.7% of the adults had never gotten their blood pressure measured by a doctor or a health person. In addition, 21.0% of the adults with raised blood pressure (>140/ 90 mmHg) were not on any medication for hypertension, which is higher than the prevalence in 2008 (16.1%). Taken together these two findings highlight the importance of popularizing already established healthy lifestyle centres, where individuals could get their blood pressure measured, and get health advices free of charge at the grass-root level. Nearly one fourth (26%) of the adults having either raised blood pressure or being on medication for hypertension warrants immediate attention on more focused prevention and control programmes.

Moreover, around half of the adults (50.9%) have never had their blood sugar measured, and around 70% of them never having their cholesterol measured also favour the implementation of a mass awareness programme throughout the country. However, it should be also noted that only 3.8% of the adults has impaired fasting glycaemia, while only 7.7% has raised bold sugar or were currently on treatment for diabetes.

Nearly one fourths of the adults (23.6%) were either had raised total cholesterol (≥ 190 mg/dl) or were currently on medication for raised cholesterol, indicating the need for more comprehensive, nation-wide interventions to prevent and control intermediate risk factors for NCD.

Approximately 9% of the adults were estimated to have cardiovascular risk ≥30% or with existing CVD. This highlights the need to identify the groups at risk in the community, and to plan and implement intervention early, in order to prevent pre-mature deaths. Out of the respondents who were having a CVD risk of ≥30% or with existing CVD, only half (55.6%) are receiving drug therapy and counselling to prevent heart attack and stroke which is highly unsatisfactory.

Exposure to a single risk factor as well as combination of more risk factors can substantially increase the risk of developing multiple NCDs. More than 90% of the Sri Lankan adults were estimated to have at least one of these risk factors (73.5% with 1-2 risk factors, and 18.3% with 3-5 risk factors), with similar prevalence in males and females. This situation should be intervened with timely implemented policies, and strategies at the national level.

NCDs will potentially emerge as a the biggest public health challenge in Sri Lanka due to the high prevalence of NCD risk factors, and the already existing gap between prevalence and treatment. However, if greater investments in NCD prevention and services are made through the right policies and public health measures, the imminent NCD epidemic could be controlled.

Health systems should be made more responsible for treatment and health-seeking behaviour. Both private and public health systems should be involved in integrating NCD services to promote as well as managing NCD patients. This requires the involvement of all government institutions as well as private sector, civil society, faith-based organizations, academia and community to have a comprehensive and multi-sectoral approach for preventing and controlling NCDs in Sri Lanka.

This National Survey was a dire need of the health sector in Sri Lanka as it gives an assessment for on-going efforts to control and prevent key risk factors for major non Communicable Diseases. Hence, the results of this survey will be a very useful tool for planning and implementation of relevant programmes in Sri Lanka.



Bibliography Department of Census and Statistics. (2012). Census of Population and Housing – 2012 (Preliminary Report). Colombo: Department of Census and Statistics.

Department of Census and Statistics. (2014, May). Department of Census and Statistics - Publications. Retrieved from Department of Census and Statistics: http://www.statistics.gov.lk/page. asp?page=Publications

Medical Statistics Unit. (2013). Annual Health Bulletin. Colombo: Ministry of Health.

Ministry of Healthcare and Nutrition. (2008). National Non Communicable Risk Factor Survey. Colombo: Ministry of Healthcare and Nutrition.

WHO. (2014). Global status report on noncommunicable diseases 2014. Geneva: WHO.

WHO. (2014). World Health Ststistics. Geneva: WHO.

WHO. (2015, February). Chronic diseases and health promotion. Retrieved February 2015, from World Health Orginization: http://www.who.int/chp/steps/esteps/en/



Annexures



Annexure I: Data Tables

1.Tobacco Use1.1: Smoked tobacco consumption

Percentage of current smokers smoking each of the following products

Men

Age Group(years)

n % Manuf.cigs.

95% CI % Hand-rolled cigs.

95% CI % Pipes of tobacco

95% CI

18-29 67 97.4 93.8-100.0 5.7 0.1-11.3 0.0 0.0-0.0

30-44 235 87.1 82.7-91.5 4.0 1.3-6.6 0.0 0.0-0.0

45-59 235 71.9 65.4-78.3 5.8 1.8-9.7 0.9 0.0-2.0

60-69 111 65.1 55.3-75.0 11.8 4.8-18.7 1.2 0.0-3.5

18-69 648 83.0 79.7-86.2 5.8 3.4-8.1 0.4 0.0-0.8

n % Cigars,* 95% CI % Shisha 95% CI % Other 95% CI

18-29 67 1.0 0.0-2.8 9.9 1.4-18.4 3.5 0.0-7.5

30-44 235 2.7 0.3-5.1 21.8 16.0-27.7 1.7 0.0-3.9

45-59 235 7.0 3.2-10.8 41.0 33.6-48.4 1.8 0.3-3.4

60-69 111 14.7 7.0-22.4 39.2 29.4-49.1 1.1 0.0-3.3

18-69 648 4.8 2.8-6.9 26.2 22.1-30.3 2.2 0.8-3.5

Women

Age Group(years)

n % Manuf. cigs.

95% CI % Hand-rolled cigs.


95% CI

18-29 0 0.0 - 0.0 - 0.0 -

30-44 0 0.0 - 0.0 - 0.0 -

45-59 4 0.0 - 0.0 - 0.0 -

60-69 0 0.0 - 0.0 - 0.0 -

18-69 4 0.0 - 0.0 - 0.0 -


18-29 0 0.0 - 0.0 - 0.0 -

30-44 0 0.0 - 0.0 - 0.0 -

45-59 4 0.0 - 19.3 19.1-19.5 80.7 80.5-80.9

60-69 0 0.0 - 0.0 0.0-0.0 0.0 -

18-69 4 0.0 - 19.3 19.1-19.5 80.7 80.5-80.9

*cigars, cheroots, cigarillos


Both sexes

Age Group(years)

n % Manuf. cigs. 95% CI % Hand-rolled cigs.


95% CI

18-29 67 97.4 93.8-100.0 5.7 0.1-11.3 0.0 0.0-0.0

30-44 235 87.1 82.7-91.5 4.0 1.3-6.6 0.0 0.0-0.0

45-59 239 70.9 64.5-77.3 5.7 1.8-9.6 0.8 0.0-2.0

60-69 111 65.1 55.3-75.0 11.8 4.8-18.7 1.2 0.0-3.5

18-69 652 82.6 79.4-85.9 5.8 3.4-8.1 0.4 0.0-0.8


18-29 67 1.0 0.0-2.8 9.9 1.4-18.4 3.5 0.0-7.5

30-44 235 2.7 0.3-5.1 21.8 16.0-27.7 1.7 0.0-3.9

45-59 239 6.9 3.2-10.7 40.7 33.3-48.1 2.9 0.8-5.0

60-69 111 14.7 7.0-22.4 39.2 29.4-49.1 1.1 0.0-3.3

18-69 652 4.8 2.7-6.9 26.2 22.1-30.3 2.5 1.0-3.9


1.2: Status of smokeless tobacco use

Smokeless tobacco use

Men

Age Group(years)

n Current user Non user

% Daily 95% CI % Non-daily 95% CI % Past user

95% CI % Never used

95% CI

18-29 294 7.4 4.4-10.4 9.1 5.5-12.8 6.2 3.4-9.0 77.2 71.9-82.6

30-44 676 21.3 17.7-25.0 7.6 5.5-9.8 5.3 3.5-7.1 65.7 61.4-70.1

45-59 689 25.4 21.6-29.3 5.4 3.5-7.3 5.0 3.1-6.8 64.2 60.1-68.4

60-69 365 34.6 29.0-40.2 2.7 0.6-4.8 7.2 4.4-10.0 55.5 49.7-61.3

18-69 2024 18.9 16.7-21.2 7.1 5.5-8.6 5.7 4.5-7.0 68.3 65.4-71.2

Women

Age Group(years)



95% CI % Never used

95% CI

18-29 504 0.5 0.0-1.3 0.4 0.0-1.0 0.6 0.0-1.2 98.5 97.3-99.6

30-44 1143 2.4 1.3-3.5 1.2 0.5-1.9 0.8 0.1-1.5 95.6 94.1-97.0

45-59 1002 7.7 5.7-9.7 2.3 1.3-3.3 2.2 1.2-3.1 87.8 85.3-90.4

60-69 502 10.7 7.3-14.1 0.7 0.0-1.4 2.1 0.7-3.5 86.5 82.8-90.2

18-69 3151 4.1 3.3-5.0 1.2 0.8-1.6 1.3 0.8-1.7 93.4 92.3-94.5

Both Sexes

Age Group(years)



95% CI % Never used

95% CI

18-29 798 4.1 2.5-5.7 5.0 3.0-6.9 3.5 2.0-5.1 87.4 84.4-90.3

30-44 1819 12.1 10.1-14.0 4.5 3.3-5.7 3.1 2.1-4.1 80.3 77.9-82.8

45-59 1691 16.4 14.1-18.7 3.8 2.7-4.9 3.5 2.5-4.6 76.3 73.6-79.0

60-69 867 22.7 19.4-26.1 1.7 0.6-2.8 4.7 3.0-6.3 70.9 67.3-74.5

18-69 5175 11.7 10.4-12.9 4.2 3.3-5.0 3.5 2.8-4.2 80.6 78.9-82.3



2. Diet2.1: Controlling salt intake

Limit consumption of processed foods

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

18-29 293 20.5 14.4-26.7 504 19.1 14.3-23.8 797 19.8 15.5-24.2

30-44 676 21.1 17.0-25.2 1143 25.3 21.6-29.1 1819 23.2 19.9-26.4

45-59 686 24.5 20.2-28.8 1002 26.1 22.0-30.1 1688 25.3 21.7-28.9

60-69 364 20.3 15.2-25.5 502 28.2 23.0-33.3 866 24.2 20.0-28.4

18-69 2019 21.7 18.2-25.1 3151 23.8 20.7-26.9 5170 22.7 19.8-25.7

Look at the salt or sodium content on food labels

18-29 293 4.6 1.2-8.0 504 6.1 3.7-8.5 797 5.3 3.1-7.5

30-44 676 5.3 3.2-7.4 1143 7.1 5.0-9.2 1819 6.2 4.5-7.9

45-59 686 6.0 3.9-8.1 1002 6.5 4.4-8.6 1688 6.3 4.5-8.0

60-69 364 4.3 2.1-6.6 502 5.3 2.5-8.1 866 4.8 3.0-6.7

18-69 2019 5.1 3.4-6.8 3151 6.4 4.9-8.0 5170 5.8 4.4-7.2

Buy low salt/sodium alternatives

18-29 293 3.5 0.3-6.7 504 2.8 1.2-4.4 797 3.1 1.3-5.0

30-44 676 2.0 0.9-3.1 1143 4.5 3.0-6.0 1819 3.2 2.1-4.3

45-59 686 2.4 1.1-3.7 1002 4.2 2.5-6.0 1688 3.3 2.0-4.7

60-69 364 1.3 0.2-2.3 502 2.5 1.0-4.0 866 1.9 0.9-2.8

18-69 2019 2.5 1.2-3.9 3151 3.6 2.5-4.7 5170 3.1 2.1-4.1

Avoid eating foods prepared outside of a home

18-29 293 12.4 7.5-17.3 504 13.4 9.6-17.2 797 12.9 9.6-16.1

30-44 676 13.3 9.9-16.7 1143 17.3 13.9-20.6 1819 15.2 12.6-17.9

45-59 686 15.5 11.9-19.1 1002 19.7 16.0-23.5 1688 17.7 14.5-20.8

60-69 364 14.5 10.3-18.7 502 17.9 13.6-22.2 866 16.2 12.7-19.7

18-69 2019 13.7 11.0-16.3 3151 16.7 14.0-19.5 5170 15.2 12.8-17.5

Avoid putting salt into rice

18-29 293 15.1 10.4-19.8 504 17.6 13.7-21.4 797 16.3 13.1-19.4

30-44 676 14.4 11.3-17.4 1143 22.9 19.8-26.0 1819 18.5 16.1-20.9

45-59 686 16.4 13.0-19.8 1002 23.5 20.0-26.9 1688 20.0 17.4-22.6

60-69 364 21.0 15.9-26.1 502 21.5 17.2-25.9 866 21.3 17.7-24.8

18-69 2019 15.8 13.4-18.3 3151 21.2 19.0-23.4 5170 18.5 16.5-20.4



3. Physical Activity3.1: Domain-specific physical activity- mean

Mean minutes of work-related physical activity on average per day

Age Group(years)


n Mean minutes

95% CI n Meanminutes


95% CI

18-29 289 128.1 106.1-150.2 503 53.3 43.1-63.5 792 92.2 78.9-105.4

30-44 660 169.1 151.8-186.5 1133 100.2 88.7-111.7 1793 135.1 123.7-146.5

45-59 675 180.2 162.6-197.9 989 97.5 86.9-108.1 1664 137.8 126.7-148.9

60-69 361 132.7 112.5-152.8 496 70.7 59.4-82.1 857 101.9 89.4-114.4

18-69 1985 153.7 141.6-165.8 3121 80.8 73.2-88.4 5106 117.7 109.4-126.0

Mean minutes of transport-related physical activity on average per day

18-29 289 33.3 23.1-43.4 503 17.4 13.9-20.9 792 25.7 19.9-31.4

30-44 660 31.0 24.4-37.7 1133 19.7 16.1-23.3 1793 25.4 21.5-29.4

45-59 675 42.6 35.4-49.9 989 27.3 22.0-32.5 1664 34.8 29.8-39.7

60-69 361 43.4 33.9-53.0 496 19.7 15.7-23.8 857 31.7 26.1-37.3

18-69 1985 36.1 30.7-41.4 3121 21.0 18.5-23.5 5106 28.6 25.3-32.0

Mean minutes of recreation-related physical activity on average per day

18-29 289 26.3 20.3-32.3 503 3.4 1.7-5.2 792 15.3 12.0-18.7

30-44 660 7.9 5.3-10.5 1133 2.3 1.2-3.4 1793 5.2 3.6-6.7

45-59 675 2.4 1.4-3.3 989 1.5 0.6-2.4 1664 1.9 1.2-2.6

60-69 361 4.4 1.5-7.3 496 2.2 0.0-4.8 857 3.3 1.3-5.3

18-69 1985 12.6 10.1-15.0 3121 2.4 1.7-3.2 5106 7.6 6.2-8.9


3.2: Composition of total physical activity

Composition of total physical activity

Age Group(years)

Men

n % Activity from work

95% CI % Activity for

transport

95% CI % Activity during

leisure time

95% CI

18-29 251 53.3 48.0-58.6 25.4 20.8-29.9 21.3 17.2-25.5

30-44 564 69.4 65.7-73.1 22.4 19.3-25.5 8.2 6.0-10.4

45-59 569 72.1 69.0-75.3 24.2 21.3-27.0 3.7 2.3-5.1

60-69 289 61.8 56.6-67.0 34.3 29.4-39.2 3.9 1.4-6.4

18-69 1673 63.7 61.0-66.3 25.1 22.9-27.3 11.2 9.4-13.1

Women

18-29 375 49.9 44.2-55.5 43.3 37.8-48.9 6.8 4.1-9.6

30-44 906 64.4 60.7-68.2 32.5 28.8-36.2 3.0 1.8-4.3

45-59 775 63.8 60.0-67.6 33.8 30.1-37.6 2.4 1.2-3.5

60-69 349 60.6 55.0-66.2 37.3 31.7-42.9 2.1 0.5-3.8

18-69 2405 59.2 56.1-62.3 36.8 33.8-39.9 4.0 2.8-5.2

Both sexes

18-29 626 51.8 47.7-55.8 33.4 29.6-37.3 14.8 12.1-17.5

30-44 1470 67.0 64.2-69.9 27.2 24.7-29.8 5.7 4.4-7.1

45-59 1344 68.0 65.4-70.6 29.0 26.5-31.5 3.0 2.1-4.0

60-69 638 61.2 57.2-65.3 35.7 31.7-39.6 3.1 1.4-4.7

18-69 4078 61.5 59.3-63.8 30.6 28.6-32.7 7.8 6.6-9.1


3.3: Sedentary activities

Minutes spent in sedentary activities on average per day

Men

Age Group (years)

n Mean minutes 95% CI Median minutes

Inter-quartile range

18-29 293 252.2 224.8-279.7 180.0 120.0-360.0

30-44 676 197.4 182.7-212.0 150.0 120.0-240.0

45-59 686 197.3 181.1-213.5 150.0 90.0-240.0

60-69 364 211.5 190.7-232.2 180.0 120.0-240.0

18-69 2019 217.9 204.1-231.7 180.0 120.0-300.0

Women

18-29 504 261.1 240.0-282.1 240.0 120.0-360.0

30-44 1143 185.2 173.9-196.5 175.0 90.0-240.0

45-59 1001 187.6 176.6-198.6 180.0 120.0-240.0

60-69 502 216.7 198.3-235.1 180.0 120.0-300.0

18-69 3150 214.1 202.9-225.4 180.0 120.0-300.0

Both sexes

18-29 797 256.5 236.7-276.3 180.0 120.0-360.0

30-44 1810 191.4 180.9-202.0 150.0 120.0-240.0

45-59 1687 192.4 181.7-203.0 150.0 120.0-240.0

60-69 866 214.1 198.2-230.0 180.0 120.0-270.0

18-69 5169 216.1 205.0-227.1 180.0 120.0-300.0



4. History of Raised Blood Pressure4.1: Blood pressure measurement and diagnosis

Blood pressure measurement and diagnosis

Men

Age Group(years)

n % Never

measured

95% CI % mesured,

not diagnosed



95% CI % found high


95% CI

18-29 293 53.7 47.4-59.9 45.5 39.3-51.8 0.7 0.0-1.8 0.1 0.0-0.4

30-44 675 39.1 34.7-43.6 55.3 50.9-59.8 2.7 1.5-3.9 2.8 1.6-4.1

45-59 686 25.4 21.6-29.3 58.3 53.9-62.8 3.8 2.2-5.4 12.5 9.6-15.3

60-69 364 17.1 12.7-21.5 57.7 51.9-63.5 6.6 3.7-9.4 18.6 14.3-23.0

18-69 2018 38.4 35.2-41.6 52.9 49.8-56.1 2.7 1.9-3.4 6.0 5.0-7.0

Women

18-29 504 39.0 33.8-44.2 57.2 51.9-62.4 3.1 1.4-4.9 0.7 0.0-1.4

30-44 1142 17.2 14.1-20.3 71.9 68.5-75.3 5.9 4.4-7.3 5.0 3.6-6.3

45-59 1000 14.5 11.6-17.4 59.6 55.9-63.3 7.6 5.6-9.5 18.3 15.5-21.1

60-69 502 9.6 6.4-12.9 47.6 42.5-52.6 9.2 6.1-12.4 33.5 29.0-38.1

18-69 3148 22.8 20.3-25.3 61.1 58.5-63.6 5.8 4.8-6.8 10.3 9.2-11.5

Both sexes

18-29 797 46.7 42.2-51.1 51.1 46.8-55.4 1.8 0.8-2.8 0.4 0.0-0.8

30-44 1817 28.4 25.3-31.6 63.4 60.3-66.6 4.2 3.3-5.2 3.9 3.0-4.8

45-59 1686 19.8 17.1-22.6 59.0 55.9-62.1 5.7 4.5-7.0 15.4 13.4-17.5

60-69 866 13.4 10.5-16.3 52.7 48.5-56.8 7.9 5.7-10.1 26.0 22.6-29.4

18-69 5166 30.7 28.3-33.1 56.9 54.6-59.3 4.2 3.6-4.8 8.1 7.3-8.9


4.2: Blood pressure advice by a traditional healer

Seen a traditional healer among those previously diagnosed

Age Group (years)


n % seen trad.healer

95% CI n % seen trad.healer

95% CI n % seen trad.healer

95% CI

18-29 3 0.0 0.0-0.0 16 0.0 0.0-0.0 19 0.0 0.0-0.0

30-44 43 2.2 0.0-6.5 123 2.9 0.0-6.2 166 2.6 0.0-5.2

45-59 105 7.8 2.4-13.3 248 5.8 2.6-9.0 353 6.6 3.5-9.6

60-69 91 10.7 3.9-17.4 213 5.6 2.1-9.1 304 7.5 4.2-10.8

18-69 242 7.4 4.0-10.8 600 4.7 2.8-6.6 842 5.7 3.9-7.5

Currently taking herbal or traditional remedy for raised blood pressure among those previously diagnosed

18-29 3 0.0 0.0-0.0 16 0.0 0.0-0.0 19 0.0 0.0-0.0

30-44 43 4.5 0.0-10.6 123 3.7 0.1-7.4 166 4.0 0.8-7.2

45-59 105 7.6 2.2-13.1 248 2.2 0.1-4.2 353 4.2 1.7-6.7

60-69 91 7.0 1.0-13.0 213 2.9 0.3-5.5 304 4.4 1.7-7.2

18-69 242 6.6 3.3-9.9 600 2.5 1.2-3.9 842 4.0 2.5-5.5


5. History of Diabetes5.1: Diabetes advice by a traditional healer

Seen a traditional healer for diabetes among those previously diagnosed

Age Group(years)


n % seen trad. healer

95% CI n % seen trad. healer

95% CI n % seen trad.

healer

95% CI

18-29 5 0.0 0.0-0.0 7 16.2 0.0-45.2 12 6.3 0.0-18.5

30-44 45 10.2 0.5-20.0 77 9.0 2.2-15.8 122 9.6 3.7-15.5

45-59 104 9.4 3.9-14.8 161 8.1 3.4-12.9 265 8.7 5.1-12.4

60-69 62 19.9 8.3-31.4 129 6.1 1.5-10.7 191 11.7 6.1-17.2

18-69 216 11.1 6.7-15.5 374 8.1 4.1-12.1 590 9.5 6.6-12.5

Currently taking herbal or traditional treatment for diabetes among those previously diagnosed

18-29 5 22.1 0.0-60.4 7 16.2 0.0-45.2 12 19.8 0.0-46.3

30-44 45 11.0 1.5-20.5 77 9.4 2.8-16.0 122 10.2 4.4-16.0

45-59 104 12.8 6.0-19.5 161 7.8 2.8-12.7 265 10.2 6.0-14.4

60-69 62 12.9 3.6-22.1 129 11.3 4.7-17.8 191 11.9 6.5-17.3

18-69 216 13.1 7.7-18.4 374 9.5 5.2-13.8 590 11.2 7.6-14.9



6. History of raised Cholesterol6.1: History of raised cholesterol

History of Raised Cholesterol

Age Group(years)

Men

n % Never measured


high



95% CI % found high


95% CI

18-29 293 87.5 83.2-91.9 11.7 7.5-15.9 0.7 0.0-1.4 0.1 0.0-0.3

30-44 675 72.9 69.0-76.8 19.8 16.4-23.3 2.3 1.2-3.4 5.0 3.2-6.8

45-59 686 62.6 58.2-67.0 25.1 21.3-28.9 3.7 2.2-5.2 8.6 6.2-10.9

60-69 364 56.6 50.6-62.6 27.6 22.3-33.0 5.9 3.1-8.7 9.8 6.2-13.5

18-69 2018 73.6 71.0-76.3 19.2 16.9-21.5 2.5 1.8-3.1 4.7 3.8-5.6

Women

18-29 504 87.1 83.7-90.5 11.9 8.6-15.2 0.4 0.0-0.9 0.6 0.0-1.5

30-44 1142 70.9 67.7-74.1 22.0 19.1-24.9 2.4 1.4-3.3 4.8 3.4-6.2

45-59 1000 52.9 49.1-56.7 27.6 24.1-31.0 3.9 2.6-5.1 15.7 13.0-18.3

60-69 502 45.3 40.0-50.6 32.3 27.5-37.1 6.4 4.0-8.8 16.0 12.4-19.6

18-69 3148 68.5 66.2-70.8 21.3 19.3-23.3 2.6 2.0-3.1 7.6 6.5-8.7

Both sexes

18-29 797 87.3 84.5-90.2 11.8 9.0-14.6 0.5 0.1-1.0 0.4 0.0-0.8

30-44 1817 71.9 69.2-74.6 20.9 18.5-23.3 2.3 1.6-3.1 4.9 3.7-6.0

45-59 1686 57.6 54.4-60.9 26.4 23.6-29.2 3.8 2.8-4.8 12.2 10.4-14.0

60-69 866 51.0 46.7-55.3 30.0 26.2-33.7 6.1 4.3-8.0 12.9 10.4-15.4

18-69 5166 71.1 69.1-73.1 20.2 18.5-21.9 2.5 2.1-3.0 6.1 5.4-6.8


6.2: Cholesterol advice by a traditional healer

Seen a traditional healer for raised cholesterol among those previously diagnosed

Age Group(years)


n % seen trad. healer



95% CI

18-29 4 0.0 0.0-0.0 4 34.8 0.0-87.2 8 19.1 0.0-51.9

30-44 50 10.0 1.3-18.7 77 10.6 3.2-17.9 127 10.3 4.5-16.0

45-59 81 9.8 3.3-16.3 194 8.3 4.2-12.5 275 8.9 5.2-12.6

60-69 56 7.5 0.2-14.9 125 4.5 0.7-8.3 181 5.8 2.1-9.5

18-69 191 9.0 4.7-13.2 400 8.7 5.1-12.4 591 8.8 6.0-11.6

Currently taking herbal or traditional treatment for raised cholesterol among those previously diagnosed

18-29 4 0.0 0.0-0.0 4 0.0 0.0-0.0 8 0.0 0.0-0.0

30-44 50 5.5 0.0-12.1 77 7.9 1.8-14.0 127 6.7 2.1-11.2

45-59 81 6.2 1.3-11.1 194 10.0 5.2-14.8 275 8.6 4.9-12.2

60-69 56 6.1 0.0-12.9 125 7.9 2.5-13.3 181 7.1 2.9-11.3

18-69 191 5.7 2.4-9.1 400 8.7 5.7-11.8 591 7.5 5.2-9.8


7. Physical Measurements7.1: Mean heart rate

Mean heart rate (beats per minute)

Age Group(years)


n mean 95% CI n mean 95% CI n mean 95% CI

18-29 272 72.6 71.3-73.9 484 80.6 79.5-81.7 756 76.4 75.5-77.3

30-44 636 73.2 72.3-74.1 1106 78.5 77.7-79.2 1742 75.8 75.2-76.4

45-59 656 73.1 72.1-74.1 965 76.8 76.1-77.6 1621 75.0 74.3-75.7

60-69 345 72.5 71.0-73.9 480 77.8 76.8-78.8 825 75.1 74.2-76.0

18-69 1909 72.9 72.2-73.5 3035 78.6 78.1-79.2 4944 75.7 75.3-76.2

7.2: Mean height

Mean height (cm)

Age Group(years)

Men Women

N Mean 95% CI n Mean 95% CI

18-29 260 167.5 166.4-168.5 447 155.0 154.2-155.7

30-44 625 165.8 165.1-166.5 1040 153.6 153.1-154.0

45-59 644 163.4 162.8-164.0 946 151.1 150.6-151.6

60-69 337 162.5 161.7-163.2 466 149.7 149.0-150.4

18-69 1866 165.4 164.9-165.9 2899 152.9 152.5-153.3

7.3: Mean weight

Mean weight (kg)

Age Group(years)

Men Women


18-29 261 60.5 58.9-62.0 448 51.4 50.3-52.6

30-44 625 63.5 62.3-64.7 1042 57.1 56.3-58.0

45-59 643 61.4 60.2-62.7 943 56.1 55.3-57.0

60-69 338 58.3 56.7-59.8 467 53.0 51.8-54.2

18-69 1867 61.4 60.6-62.2 2900 54.6 54.0-55.2

7.4: Mean BMI

Mean BMI (kg/m2)

Age Group(years)



18-29 257 21.7 21.2-22.1 438 21.5 21.1-21.9 695 21.6 21.2-21.9

30-44 625 23.1 22.7-23.4 1034 24.3 23.9-24.6 1659 23.6 23.4-23.9

45-59 640 22.8 22.5-23.2 938 24.7 24.4-25.1 1578 23.8 23.5-24.0

60-69 337 22.1 21.5-22.6 462 23.7 23.2-24.3 799 22.9 22.5-23.3

18-69 1859 22.4 22.2-22.7 2872 23.5 23.2-23.7 4731 22.9 22.7-23.1



8. Biochemical measurements 8.1: Total cholesterol measurements

Total Cholesterol (mg/dl)

Age group



18-29 235 137.0 131.3-142.7 432 147.1 141.9-152.3 667 141.8 137.8-145.8

30-44 583 150.9 146.4-155.5 1018 155.2 151.7-158.8 1601 153.0 149.7-156.4

45-59 603 153.6 149.1-158.0 909 167.5 163.0-172.1 1512 160.7 157.1-164.3

60-69 321 151.7 145.7-157.7 446 172.4 166.6-178.2 767 162.0 157.5-166.5

18-69 1742 146.8 143.6-150.0 2805 157.8 154.7-160.9 4547 152.2 149.5-154.9



Annexure II: STEPS Instrument

WHO STEPS Instrument for Chronic Disease

Risk Factor Surveillance Sri Lanka

Survey Information

Location and Date Response Code

Cluster ID

└─┴─┴─┴─┴─┴─┘ I1

Name of the PHM Area I2

Interviewer ID └─┴─┴─┘ I3

Date of completion of the instrument

└─┴─┘ └─┴─┘ └─┴─┴─┴─┘ dd mm year

I4

Consent, Interview Language and Name Response Code

Consent has been read and obtained Yes 1

I5 No 2 If NO, END

Interview Language

English 1

I6 Sinhalese 2

Tamil 3

Name of the participant I7

Address and a landmark

I8 I9

Additional Information that may be helpful Contact phone number where possible I10

Step 1 Demographic Information

CORE: Demographic Information Question Response Code

Sex Male 1

C1 Female 2

What is your date of birth? Don't Know 77 77 7777

└─┴─┘ └─┴─┘ └─┴─┴─┴─┘ If known, Go to C4 dd mm year

C2

How old are you? Years └─┴─┘ C3

In total, how many years have you spent at school and in full-time study (excluding pre-school)?

Years └─┴─┘

C4


Step 1 Behavioural Measurements

CORE: Tobacco Use Now I am going to ask you some questions about tobacco use. Question Response Code

Do you currently smoke any tobacco products, such as cigarettes, cigars, Beedee, pipes? (USE SHOWCARD)

Yes 1

T1 No 2 If No, go to T10

Do you currently smoke tobacco products daily? This question is only for current smokers of tobacco products.

Yes 1 T2

No 2

How old were you when you first started smoking? For current smokers only.

Age (years)

└─┴─┘ If Known, go to T6a/T6aw T3

Don’t know 77

Who introduced you to smoking?

School Friends 1 Work place colleagues

2 Relations 3

Self 4 Can’t remember 5

T4

Do you remember how long ago it was? (RECORD ONLY 1, NOT ALL 3) Don’t know 77

In Years └─┴─┘ If Known, go to T6a/T6aw T5a

OR in Months └─┴─┘ If Known, go to T6a/T6aw T5b

OR in Weeks └─┴─┘ T5c

On average, how many of the following products do you smoke each day/week? (IF LESS THAN DAILY, RECORD WEEKLY) (RECORD FOR EACH TYPE, USE SHOWCARD) Don’t Know 7777 For current smokers only.

DAILY↓ WEEKLY↓ Manufactured

cigarettes └─┴─┴─┴─┘└─┴─┴─┴─┘ T6a/T6aw

If T6a/T6aw answered go T7 Hand-rolled

cigarettes └─┴─┴─┴─┘└─┴─┴─┴─┘ T6b/T6bw

Pipes full of tobacco └─┴─┴─┴─┘└─┴─┴─┴─┘ T6c/T6cw

Cigars, cheroots, cigarillos └─┴─┴─┴─┘└─┴─┴─┴─┘ T6d/T6dw

Manufactured Beedee └─┴─┴─┴─┘└─┴─┴─┴─┘ T6e/T6ew

Other └─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T6other, else go to T8

T6f/T6fw

Other (please specify): └─┴─┴─┴─┴─┴─┘

T6other/ T6otherw

Usually, do you buy cigarettes in packets or separately?

Packets 1

Separately 2 T7

During the past 12 months, have you tried to stop smoking? For current smokers only.

Yes 1

T8 No

2


During any visit to a doctor or other health worker in the past 12 months, were you advised to quit smoking tobacco? For current smokers only.

Yes 1 If T2=Yes, go to T14; if T2=No, go to T11

T9 No 2 If T2=Yes, go to T14; if T2=No, go to T11

No visit during the past 12 months 3 If T2=Yes, go to T14; if T2=No, go to T11

In the past, did you ever smoke any tobacco products? (USE SHOWCARD) cross check

Yes 1


In the past, did you ever smoke daily?

Yes 1 If T1=Yes, go to T14, else go to T12 T11 No 2 If T1=Yes, go to T14, else go to T12

EXPANDED: Tobacco Use Question Response Code

How old were you when you stopped smoking?

Age (years)

└─┴─┘ If Known, go to T14 T12

Don’t Know 77

How long ago did you stop smoking? (RECORD ONLY 1, NOT ALL 3) Don’t Know 77

Years ago └─┴─┘ If Known, go to T14 T13a

OR Months ago └─┴─┘ If Known, go to T14 T13b

OR Weeks ago └─┴─┘ T13c

Do you currently use any smokeless tobacco products such as [chewing tobacco, betel with tobacco, babul, snuff]? (USE SHOWCARD)

Yes 1


Do you currently use smokeless tobacco products daily? For current users of smokeless tobacco products only.

Yes 1 T15

No 2 If No, go to T16aw

On average, how many times a day/week do you use …. (IF LESS THAN DAILY, RECORD WEEKLY) (RECORD FOR EACH TYPE, USE SHOWCARD) Don’t Know 7777 For current users of smokeless tobacco only.

DAILY↓ WEEKLY↓

Chewing tobacco with betel └─┴─┴─┴─┘└─┴─┴─┴─┘ T16a/ T16aw

Snuff, by nose └─┴─┴─┴─┘└─┴─┴─┴─┘ T16b/ T16bw

Chewing tobacco └─┴─┴─┴─┘└─┴─┴─┴─┘ T16c/ T16cw

Babul └─┴─┴─┴─┘└─┴─┴─┴─┘ T16d/ T16dw

Other

└─┴─┴─┴─┘└─┴─┴─┴─┘ If Other, go to T16other, if T15=No, go to T18, else go to T19

T16e/ T16ew

Other (please specify): └─┴─┴─┴─┴─┴─┘

If T15=No, go to T18, else go to T19

T16other/ T16otherw

In the past, did you ever use smokeless tobacco products such as [chewing tobacco, betel with tobacco, babul, snuff]?

Yes 1



In the past, did you ever use smokeless tobacco products [such as chewing tobacco, betel with tobacco, babul, snuff ] daily?

Yes 1

T18 No 2

During the past 30 days, did someone smoke in your home?

Yes 1

T19 No 2

During the past 30 days, did someone smoke in closed areas in your workplace (in the building, in a work area or a specific office)?

Yes 1

T20

No 2

Don't work in a closed area

3


CORE: Alcohol Consumption Question Response Code

Have you ever consumed any alcohol such as arrack, kasippu, toddy, beer, spirits or wine (USE SHOWCARD OR SHOW EXAMPLES)

Yes 1 No 2

If No, go to D 1 ###############

A1

Have you consumed any alcohol within the past 12 months?

Yes 1 If Yes, go to A4 A2

No 2

###################################

During the past 12 months, how frequently have you had at least one standard alcoholic drink? (READ RESPONSES, USE SHOWCARD)

Daily 1

A4

5-6 days per week 2

3-4 days per week 3

1-2 days per week 4

1-3 days per month 5

Less than once a month 6

Have you consumed any alcohol within the past 30 days?

Yes 1 A5

No 2 If No, go to D1 #############

During the past 30 days, on how many occasions did you have at least one standard alcoholic drink?

Daily

5-6 days per week

3-4 days per week

1-2 days per week

1-3 days per month

A6

During the past 30 days, when you drank alcohol, how many standard drinks on average did you have during one drinking occasion? (USE SHOWCARD)

Number Don't know 77

└─┴─┘

A7

During the past 30 days, what was the largest number of standard drinks you had on a single occasion, counting all types of alcoholic drinks together?

Largest number Don't Know 77

└─┴─┘

A8

During the past 30 days, how many times did you have six or more standard drinks in a single drinking occasion?

Number of times Don't Know 77

└─┴─┘

A9

During each of the past 7 days, how many standard drinks did you have each day? (USE SHOWCARD) Don't Know 77

Monday └─┴─┘ A10a

Tuesday └─┴─┘ A10b

Wednesday └─┴─┘ A10c

Thursday └─┴─┘ A10d

Friday └─┴─┘ A10e

Saturday └─┴─┘ A10f

Sunday └─┴─┘ A10g


Have you stopped drinking due to health reasons, such as a negative impact on your health or on the advice of your doctor or other health worker? This question is for those participants that did not drink during the past 12 months, but that have drunk in their lifetime.

Yes 1 If Yes, go to A16 No 2 If No, go to A16 A3

CORE: Alcohol Consumption, continued I have just asked you about your consumption of alcohol during the past 7 days. The questions were about alcohol in general, while the next questions refer to your consumption of homebrewed alcohol, alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol. Please only think about these types of alcohol when answering the next questions.

During the past 7 days, did you consume any homebrewed alcohol, any alcohol brought over the border/from another country, any alcohol not intended for drinking or other untaxed alcohol? [AMEND ACCORDING TO LOCAL CONTEXT] (USE SHOWCARD)

Yes 1

A11 No 2 If No, go to D1 ##############

On average, how many standard drinks of the following did you consume during the past 7 days? [INSERT COUNTRY-SPECIFIC EXAMPLES] (USE SHOWCARD) Don't Know 77

Homebrewed spirits, e.g. moonshine └─┴─┘ A12a

Homebrewed beer or wine, e.g. beer, palm or fruit wine └─┴─┘ A12b

Alcohol brought over the border/from another country └─┴─┘ A12c

Alcohol not intended for drinking, e.g. alcohol-based medicines,

perfumes, after shaves └─┴─┘ A12d

Other untaxed alcohol in the country

└─┴─┘ A12e

CORE: Diet Question Response Code

In a typical week, on how many days do you eat fruit? (USE SHOWCARD)

Number of days Don't Know 77

└─┴─┘ If Zero days, go to D4

D1

How many servings of fruit do you eat on one of those days? (USE SHOWCARD)

Number of servings Don't Know 77

└─┴─┘

D2

During the past 30 days on how many days did you eat fruits?

Daily 1 5-6 days per week 2 3-4 days per week 3 1-2 days per week 4

1-3 days per month 5

D3


In a typical week, on how many days do you eat vegetables? (USE SHOWCARD)

Number of days Don't Know 77

└─┴─┘ If Zero days, go to D6

D4

How many servings of vegetables do you eat on one of those days? (USE SHOWCARD)

Number of servings Don’t know 77

└─┴─┘

D5

EXPANDED: Diet

What type of oil or fat is most often used for meal preparation in your household? (USE SHOWCARD) (SELECT ONLY ONE) .

Soya 1

D6

Vegetable (palm) 2 Sunflower 3 Gingerly 4 Olive oil 5 Corn oil 6 Coconut oil 7 Ghee 8 Butter 9 Margarine 10

Other 11 If Other, go to D6 other

None in particular 12 None used 13 Don’t know 77

Other

└─┴─┴─┴─┴─┴─┴─┘ D6other

On average, how many meals per week do you eat that were not prepared at a home? By meal, I mean breakfast, lunch and dinner.

Number Don’t know 77

└─┴─┘

D7


Dietary Salt

Dietary salt Question Response Code How often do you add salt when you cook rice? Always 1

Often 2 Sometimes 3

Rarely 4 Never 5

Don't know 77

DS1

How often do you add salt or a salty sauce such as soya sauce to your food right before you eat it or as you are eating it?

(USE SHOWCARD)

Always 1

DS2

Often 2 Sometimes 3

Rarely 4 Never 5

Don't know 77

How often is salt, salty seasoning added in cooking or preparing foods in your household?

Always 1

DS3

Often 2 Sometimes 3

Rarely 4 Never 5

Don't know 77

How often do you eat processed food high in salt? *** (USE SHOWCARD)

Always 1

DS4

Often 2 Sometimes 3

Rarely 4 Never 5

Don't know 77

On average for how many people do you cook in a typical day? DS5

How many salt packets do you consume in a month?

Salt crystals (1kg) No. of packets Salt powder(400g) No. of packets

Don't know 77

DS6

How much salt or salty sauce do you think you consume?

Far too much 1

DS7

Too much 2 Just the right amount 3

Too little 4 Far too little 5

Don't know 77

How important to you is lowering the salt in your diet?

Very important 1

DS8 Somewhat important 2

Not at all important 3

Don't know 77

Do you think that too much salt or salty sauce in your diet could cause a health problem?

Yes 1 DS9 No 2

Don't know 77


Dietary salt, Continued Question Response Code Do you do anything of the following on a regular basis to control your salt intake? (RECORD FOR EACH)

Limit consumption of processed foods Yes 1 DS10a No 2

Look at the salt or sodium content on food labels Yes 1 DS10b No 2

Not to put salt into rice Yes 1

DS10c No 2

Use spices other than salt when cooking Yes 1 DS10d No 2

Avoid eating foods prepared outside of a home Yes 1 DS10e No 2

Do other things specifically to control your salt intake Yes 1 If Yes, go to S7other DS10f No 2

Other (please specify) └─┴─┴─┴─┴─┴─┴─┘

DS10other


CORE: Physical Activity Question Response Code Work Does your work involve vigorous-intensity activity that causes large increases in breathing or heart rate like [carrying or lifting heavy loads, digging or construction work] for at least 10 minutes continuously? (USE SHOWCARD)

Yes 1

P1 No 2 If No, go to P 4

In a typical week, on how many days do you do vigorous -intensity activities as part of your work?

Number of days └─┘

P2

How much time do you spend doing vigorous-intensity activities at work on a typical day?

Hours : minutes └─┴─┘: └─┴─┘ hrs mins

P3 (a-b)

Does your work involve moderate-intensity activity, that causes small increases in breathing or heart rate such as brisk walking [or carrying light loads] for at least 10 minutes continuously? (USE SHOWCARD)

Yes 1

P4 No 2 If No, go to P 7

In a typical week, on how many days do you do moderate -intensity activities as part of your work?

Number of days

└─┘

P5

How much time do you spend doing moderate-intensity activities at work on a typical day?


P6 (a-b)

Travel to and from places The next questions exclude the physical activities at work that you have already mentioned. Now I would like to ask you about the usual way you travel to and from places. For example to work, for shopping, to market, to place of worship. [Insert other examples if needed]

Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously to get to and from places?

Yes 1 P7

No 2 If No, go to P 10

In a typical week, on how many days do you walk or bicycle for at least 10 minutes continuously to get to and from places?

Number of days └─┘

P8

How much time do you spend walking or bicycling for travel on a typical day? Hours : minutes └─┴─┘: └─┴─┘

hrs mins

P9 (a-b)

CORE: Physical Activity, Continued Question Response Code Recreational activities The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities (leisure), [Insert relevant terms]. Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate like [running or football] for at least 10 minutes continuously? [INSERT EXAMPLES] (USE SHOWCARD)

Yes 1 P10

No 2 If No, go to P 13


In a typical week, on how many days do you do vigorous -intensity sports, fitness or recreational (leisure) activities? Number of days

└─┘ P11

How much time do you spend doing vigorous-intensity sports, fitness or recreational activities on a typical day?


P12 (a-b)

Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause a small increase in breathing or heart rate such as brisk walking, [cycling, swimming, and volleyball] for at least 10 minutes continuously? (USE SHOWCARD)

Yes 1

P13 No 2 If No, go to P16

In a typical week, on how many days do you do moderate -intensity sports, fitness or recreational (leisure) activities? Number of days

└─┘ P14

How much time do you spend doing moderate-intensity sports, fitness or recreational (leisure) activities on a typical day? Hours : minutes

└─┴─┘: └─┴─┘ hrs mins

P15 (a-b)

EXPANDED: Physical Activity Sedentary behaviour The following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting at a desk, sitting with friends, traveling in car, bus, train, reading, playing cards or watching television, but do not include time spent sleeping. (USE SHOWCARD)

How much time do you usually spend sitting or reclining on a typical day?


P16 (a-b)

How many hours of sleep do you get per day, in a typical week? Hours

└─┴─┘

P17


Health Care

Health Care Health Care Coverage Please provide information about your current health insurance coverage.

Do you currently have health insurance? Yes 1 HC1 No 2 If No, go to HC3

During the past 12 months, which of the following financial sources did you use to pay for any health expenditures such as medicines, consultations, treatment, hospitalization or patient care?

Current income of any household members

Yes 1 HC2a No 2

Savings (e. g. bank account) Yes 1 HC2b No 2

Payment or reimbursement from a health insurance plan

Yes 1 HC2c No 2 Sold items (e. g. furniture,

animals, jewellery) Yes 1 HC2d No 2

Family members or friends from outside the household

Yes 1 HC2e No 2 Borrowed from someone other

than a friend or family Yes 1 HC2f No 2

Other Yes 1 If Other, go to HC3other HC2g No 2

Other (please specify):

└─┴─┴─┴─┴─┴─┴─┘ HC2 other

Health Care Utilization Please think about your visits to any health center and the treatments you received there which were related to an NCD you may have.

Have you ever had or do you currently have a non-communicable disease (NCD) such as cardiovascular disease including heart disease and stroke, cancer, chronic respiratory disease, or diabetes?

Yes 1

HC3 No 2 If No, go to [next section]

Have you ever visited any health care facility due to an NCD you have? Please exclude any hospitalization.

Yes 1 HC4

No 2 If No, go to HC10

How much time did you spend traveling the last time you visited a health care facility (taking both ways into account)? Don’t know 77:77:77

Days : hours : minutes └─┴─┘ : └─┴─┘ : └─┴─┘ days hrs mins

HC5

How long was the waiting time before your appointment started when you last visited a health care facility? Don’t know 77:77

Hours : minutes └─┴─┘: └─┴─┘

hrs mins

HC6

During the past 30 days, have you visited any health care facility due to an NCD you have? Please exclude any hospitalization.

Yes 1 HC7

No 2 If No, go to HC11


Health Care, continued

During the past 30 days, how many times have you visited a health care facility due to an NCD you have? (RECORD FOR EACH) [INSERT COUNTRY-SPECIFIC CATEGORIES] Don’t know 77

Health Center └─┴─┘ HCa

Public Hospital └─┴─┘ HC8b

Private Hospital └─┴─┘ HC8c

Doctor’s Office └─┴─┘ HC8d

Other └─┴─┘ If Other, go to HC8other HC8e

Other (please specify): └─┴─┴─┴─┴─┴─┘ HC8other

During the past 30 days, taking all your visits to a health care facility due to an NCD into account, how much did you pay yourself for these visits in total? (RECORD FOR EACH OR PUT TOTAL AMOUNT) Don’t know 77777

Health care provider’s fees └─┴─┴─┴─┴─┘[Rupees] HC9a

Medicines └─┴─┴─┴─┴─┘[Rupees] HC9b

Tests └─┴─┴─┴─┴─┘[Rupees] HC9c

Transport └─┴─┴─┴─┴─┘[Rupees] HC9d

Other └─┴─┴─┴─┴─┘[Rupees] HC9e

OR Total Amount └─┴─┴─┴─┴─┘[Rupees] HC9f During the past 30 days, how much did you pay yourself for health care not related to any visit of a health care facility or hospital, such as routine medication? Don’t know 77777

Amount └─┴─┴─┴─┴─┘ [Rupees] HC10

During the past 12 months, have you been hospitalized due to an NCD?

Yes 1 HC11 No 2 If No, go to H1 During the past 12 months, how many days have you been hospitalized due to an NCD? Don’t know 777

Number of days └─┴─┴─┘ HC12


CORE: History of Raised Blood Pressure Question Response Code

Have you ever had your blood pressure measured by a doctor or other health worker?

Yes 1 H1

No 2 If No, go to H6

Have you ever been told by a doctor or other health worker that you have raised blood pressure or hypertension?

Yes 1 H2a


Have you been told in the past 12 months? Yes 1

H2b No 2

In the past two weeks, have you taken any drugs (medication) for raised blood pressure prescribed by a doctor or other health worker?

Yes 1 H3

No 2

Have you ever seen a traditional healer for raised blood pressure or hypertension?

Yes 1 H4

No 2

Are you currently taking any herbal or traditional remedy for your raised blood pressure?

Yes 1 H5

No 2

CORE: History of Diabetes Question Response Code

Have you ever had your blood sugar measured by a doctor or other health worker?

Yes 1 H6


Have you ever been told by a doctor or other health worker that you have raised blood sugar or diabetes?

Yes 1 H7a



H7b No 2

In the past two weeks, have you taken any drugs (medication) for diabetes prescribed by a doctor or other health worker?

Yes 1 H8

No 2

Are you currently taking insulin for diabetes prescribed by a doctor or other health worker?

Yes 1 H9

No 2

Have you ever seen a traditional healer for diabetes or raised blood sugar?

Yes 1 H10

No 2

Are you currently taking any herbal or traditional remedy for your diabetes?

Yes 1 H11

No 2

Have you ever been told by a doctor or other health worker that you have Gestational Diabetes?

Yes 1 No 2 H12


CORE: History of Raised Total Cholesterol Questions Response Code Have you ever had your cholesterol (fat levels in your blood) measured by a doctor or other health worker?

Yes 1 H13


Have you ever been told by a doctor or other health worker that you have raised cholesterol?

Yes 1 H14a



H14b No 2

In the past two weeks, have you taken any oral treatment (medication) for raised total cholesterol prescribed by a doctor or other health worker?

Yes 1 H15

No 2

Have you ever seen a traditional healer for raised cholesterol? Yes 1

H16 No 2

Are you currently taking any herbal or traditional remedy for your raised cholesterol?

Yes 1 H17

No 2

CORE: History of Cardiovascular Diseases Question Response Code

Have you ever had a heart attack or chest pain from heart disease (angina)?

Yes 1 H18

No 2

Have you ever had a stroke (Cerebrovascular accident or incident)?

Yes No

1 2

H19

Are you currently taking aspirin regularly to prevent or treat heart disease? “Regularly” means on a daily or almost daily basis.

Yes 1 H20

No 2

Are you currently taking statins (Lovostatin/Simvastatin/Atorvastatin or any other statin) regularly to prevent or treat heart disease? “Regularly” means on a daily or almost daily basis.

Yes 1 H21

No 2

CORE: Lifestyle Advice Questions Response Code During the past three years, has a doctor or other health worker advised you to do any of the following? (RECORD FOR EACH)

Do not smoke or chew tobacco Yes 1

H22a No 2

Reduce salt in your diet Yes 1

H22b No 2

Eat at least five servings of fruit and/or vegetables each day Yes 1

H22c No 2

Reduce fat in your diet Yes 1

H22d No 2

Start or do more physical activity Yes 1

H22e No 2

Maintain a healthy body weight or lose weight Yes 1 If C1=1 go to M1

H22f No 2 If C1=1 go to M1


CORE (for women only): Cervical Cancer Screening Question Response Code

Have you ever had a screening test for cervical cancer, using any of these methods (VIA, Pap, HPV)?

Yes 1

CX1 No 2

Don’t know 77


Step 2 Physical Measurements

CORE: Blood Pressure

Interviewer ID

└─┴─┴─┘ M1

Device ID for blood pressure └─┴─┘ M2

Cuff size used Small 1

M3 Medium 2 Large 3

Reading 1 Systolic ( mmHg) └─┴─┴─┘ M4a

Diastolic (mmHg) └─┴─┴─┘ M4b





During the past two weeks, have you been treated for raised blood pressure with drugs (medication) prescribed by a doctor or other health worker?

Yes 1 M7

No 2

CORE: Height and Weight Question Response Code

For women: Are you pregnant? Yes 1 If Yes, go to M 16

M8 No 2

Interviewer ID └─┴─┴─┘ M9

Device IDs for height and weight Height └─┴─┘ M10a Weight └─┴─┘ M10b

Height in Centimetres (cm) └─┴─┴─┘. └─┘

M11

Weight If too large for scale 666.6 in Kilograms (kg)

└─┴─┴─┘.└─┘ M12

CORE: Waist

Device ID for waist

└─┴─┘ M13

Waist circumference in Centimetres (cm) └─┴─┴─┘.└─┘

M14


Step 3 Biochemical Measurements

CORE: Blood Glucose Question Response Code

During the past 12 hours have you had anything to eat or drink, other than water?

Yes 1 B1

No 2

Technician ID └─┴─┴─┘ B2

Device ID

└─┴─┘ B3

Time of day blood specimen taken (24 hour clock) Hours : minutes └─┴─┘: └─┴─┘ hrs mins

B4

Fasting blood glucose [CHOOSE ACCORDINGLY: MMOL/L OR MG/DL]

mmol/l └─┴─┘. └─┴─┘ B5 mg/dl └─┴─┴─┘.└─┘

Today, have you taken insulin or other drugs (medication) that have been prescribed by a doctor or other health worker for raised blood glucose?

Yes 1 B6

No 2

CORE: Blood Lipids

Device ID └─┴─┘ B7

Total cholesterol [CHOOSE ACCORDINGLY: MMOL/L OR MG/DL]

mmol/l └─┴─┘. └─┴─┘ B8 mg/dl └─┴─┴─┘.└─┘

During the past two weeks, have you been treated for raised cholesterol with drugs (medication) prescribed by a doctor or other health worker?

Yes 1 B9 No 2


Annexure III: Factsheet on NCD Risk Factors

FACTSHEET Sri LankaNon Communicable Diseases Risk Factors: STEPS Survey Sri Lanka 2014

The STEPS survey of noncommunicable disease (NCD) risk factors in Sri Lanka was carried out from July 2014–May 2015. Sri Lanka carried out Step 1, Step 2 and Step

3. Socio demographic and behavioural information was collected in Step 1.

Physical measurements such as height, weight and blood pressure

were collected in Step 2. Biochemical measure-ments were collected to assess salt intake, blood glucose and cholesterol levels in Step 3.

The survey was a

population-based survey of adults aged 18-69. A multi-stage strati�ed cluster sampling design was used to produce representative data for that age range in

Sri Lanka.

A total of 5188 adults participated in the survey. The overall response rate was 72%.

Results for adults aged 18-69 years Both Sexes Males Females

Step 1: Tobacco Use

Step 1: Alcohol Consumption

Percentage who currently smoke tobacco

Percentage who currently smoke tobacco daily

Percentage who currently use smokeless tobacco

Percentage who currently use smokeless tobacco daily

Percentage who currently use tobacco in any any form (smoked

and/ or smokeless)

For those who smoke tobacco daily

Average age started smoking (years)

Percentage of daily smokers smoking manufactured cigarettes

Mean number of manufactured cigarettes smoked per day

(by smokers of manufactured cigarettes)

Percentage who are lifetime abstainers

Percentage who are past 12 month abstainers

Percentage who currently drink (drank alcohol in the past 30 days)

Percentage who engage in heavy episodic drinking (6 or more drinks on

any occasion in the past 30 days)

Step 1: Physical Activity

Percentage with insu�cient physical activity (de�ned as < 150 minutes

of moderate-intensity activity per week, or equivalent)*

Median time spent in physical activity on average per day (minutes)

(presented with inter-quartile range)

Percentage not engaging in vigorous activity

Step 1: Diet

Mean number of days fruit consumed in a typical week

Mean number of servings of fruit consumed on average per day

Mean number of days vegetables consumed in a typical week

Mean number of servings of vegetables consumed on average per day

Percentage who ate less than 5 servings of fruit and/or vegetables on

average per day

Percentage who always or often add salt or salty sauce to their food before

eating or as they are eating

Percentage who always or often eat processed foods high in salt

15.0%

10.2%

15.8%

11.7%

25.8%

20.7

82.9%

3.7

29.4%

19.9%

26.0%

19.0%

47.7%

20.5

82.4%

3.7

0.1%

0.1%

5.3%

4.1%

5.3%

46.2

0.0%

0.0

67.9%

5.8%

17.9%

8.6%

40.2%

9.7%

34.8%

16.8%

96.4%

1.8%

0.5%

0.1%

30.4%

77.1

73.6%

22.5%

124.3

58.3%

38.4%

42.8

89.2%

3.6

1.3

6.6

3.0

72.5%

21.8%

26.6%

3.5

1.3

6.5

3.0

73.1%

21.8%

28.3%

3.8

1.3

6.6

3.1

72.0%

21.8%

24.8%


Systolic

Mean BLOOD PRESSURE

Diastolic

OVERWEIGHT25% 34%

% with raised fasting fasting BLOOD SUGAR

7.4%

21% having HIGH BLOOD PRESSUREwere not on medicaiton

126.8(mmHg)

146.6(mg/dl)

157.5(mg/dl)

123.4(mmHg)

80.5(mmHg)

80.4(mmHg)

25% of women aged 30-49 years who have ever had a screening test for CERVICAL CANCER

Mean total BLOOD CHOLESTEROL, including those currently on medication for raised cholesterol

Sri Lanka


SMOKE29% 0.1%

SMOKELESSTOBACCO26% 5%

TOBACCOUSE46% 5%

WORKPLACE

1 out of 4 1 out of 5

ALCOHOL DRINKERS 35% <1%

HOME

SECOND HAND SMOKING

73% do not consume su�cient fruits and vegetables

Sri Lanka



Tobacco Factsheet

Sri Lanka STEPS Survey 2015

The WHO STEPwise approach to surveillance (STEPS) is a simple, standardized method for collecting, analysing and disseminating data on noncommunicable diseases (NCDs) and risk factors. Data are collected on the established risk factors and NCD conditions that determine the major NCD burden, including tobacco use, harmful use of alcohol, unhealthy diet,

insufficient physical activity, overweight and obesity, raised blood pressure, raised blood glucose, and abnormal blood lipids. Data from STEPS surveys can be used by countries to help monitor progress in meeting the global voluntary targets related to specific risk factors such as tobacco, alcohol, diet and physical inactivity. The tobacco indicators from STEPS can be

used to evaluate and monitor existing tobacco-control policies and programs.*

The STEPS survey on NCD risk factors in Sri Lanka was carried out from July 2014 to May 2015. The STEPS survey in Sri Lanka was a population-based survey of adults aged 18-69 years. A multi stage cluster sampling design was used to produce representative data for that age

range in Sri Lanka. Survey information was collected electronically using handheld devices. The survey was implemented by the Ministry of Health, Nutrition & Indigenous Medicine. A total of 5188 adults participated in the Sri Lanka STEPS survey. The overall response rate was 72%. A repeat survey is planned for 2018 if funds permit.

Highlights

Tobacco Use

Cessation

45.7% of men, 5.3 % of women, and 25.8 % overall were current users of tobacco, in any form.

29.4% of men, 0.1% of women, and 15.0% overall were current smokers of tobacco.

26.0 % of men, 5.3 % of women, and 15.8 % overall were current users of smokeless tobacco.

1 in 2 current smokers tried to stop smoking in the last 12 months.

3 in 10 current smokers were advised by a health care provider to stop smoking in the last 12 months.

Secondhand smoke

1 in 4 adults were exposed to tobacco smoke at the workplace.

1 in 4 adults were exposed to tobacco smoke at home.

Economics

Average monthly expenditure on manufactured cigarettes was 2695.00 Sri Lankan Rupees.

Media

9 in 10 adults noticed anti-cigarette smoking information on the television.

1 in 2 adults noticed anti-cigarette smoking information on the radio.

3 in 10 current smokers thought about quitting because of warning labels on cigarette packages.

1 in 10 adults noticed cigarette marketing in stores where cigarettes are sold.

3 in 100 adults noticed any form of cigarette promotions.

Data presented in this fact sheet relate only to select tobacco indicators. Additional information on tobacco or other NCD risk factors from the survey is available from sources listed below.

For additional information, please contact:WHO STEPS Team [[email protected]]

STEPS country focal point Dr. Lakshmi C. Somatunga email: [email protected]*Tobacco questions are drawn from the Tobacco Questions for Surveys(TQS)

http://www.who.int/tobacco/publications/surveillance/tqs/en

Ministry of HealthNutrition and Indigenous medicine

Annexure IV: Tabacco Factsheet


Results for adults aged 18-69 years

Overall%

(95% CI)

Males%

(95% CI)

Females%

(95% CI)

Tobacco use

Current tobacco users (smoked and/or smokeless)1

Current tobacco users

Current daily tobacco users

Current tobacco smokers

Current tobacco smokers

Current cigarette smokers2

Current daily tobacco smokers

Current daily cigarette smokers

Average age started tobacco smoking (years)

Average number of cigarettes smoked per day (among daily cigarette

smokers)

Current smokeless tobacco users

Current smokeless tobacco users

Current daily smokeless tobacco users

Current non-users (smoked and/or smokeless)1

Former tobacco users3

Former tobacco smokers4

Never users

25.8 (24.1-27.6)

20.0 (18.5-21.5)

15.0 (13.6-16.4)

15.7 (13.7-17.6)

10.2 (9.1-11.3)

7.9 (6.9-9.0)

20.6 (20.1-21.1)

5.1 (4.3-5.9)

15.8 (14.3-17.4)

11.7 (10.4-12.9)

6.7 (5.7-7.7)

8.5 (7.4-9.6)

67.4 (65.6-69.3)

45.7 (42.7-48.6)

35.3 (32.6-38.0)

29.4 (26.8-31.9)

24.5 (22.0-27.1)

19.9 (17.8-22.0)

12.4 (11.1-13.7)

20.5 (20.0-20.9)

5.1 (4.3-5.9)

26.0 (23.3-28.8)

18.9 (16.7-21.2)

12.0 (10.2-13.8)

16.7 (14.6-18.7)

42.3 (39.3-45.4)

5.3 (4.3-6.3)

4.1 (3.3-5.0)

**

**

**

**

**

**

5.3 (4.3-6.3)

4.1 (3.3-5.0)

1.3 (0.8-1.7)

0.0 (0.0-0.1)

93.4 (92.2-94.5)

Exposure to Second-hand smoke

Adults exposed to second-hand smoke at home*

Adults exposed to second-hand smoke in the closed areas in their

workplace*

23.5 (21.5-25.5)

24.1 (21.4-26.8)

25.2 (22.5-28.0)

36.1 (32.2-39.9)

21.6 (19.3-23.9)

11.1 (8.7-13.6)

Tobacco Cessation

Current smokers who tried to stop smoking in past 12 months

Current smokers advised by a health care provider to stop smoking in

past 12 months5

51.8 (46.9-56.7)

35.0 (30.0-40.1)

51.8 (46.9- 56.8)

35.2 (30.1-40.2)

**

**

Health Warnings

Current smokers who thought about quitting because of a warning label*

Adults who noticed anti-cigarette smoking information on the television*

Adults who noticed anti-cigarette smoking information on the radio*

Adults who noticed anti-cigarette smoking information in newspapers or magazines*

54.6 (48.6-60.5)

86.3 (84.1-88.4)

49.8 (46.4-53.3)

64.4 (61.2-67.6)

54.5 (48.5-60.4)

87.7 (85.2-90.2)

51.4 (47.4-55.4)

67.8 (64.1-71.4)

Tobacco Advertisement and Promotion

Adults who noticed cigarette marketing in stores where cigarettes are sold*

Adults who noticed any cigarette promotions*

11.5 (9.5-13.4)

2.8 (2.0- 3.6)

14.7 (11.9-17.5)

4.4 (3.0- 5.8)

7.9 (6.1-9.6)

0.9 (0.5-1.4)

Economics Local Currency LKR

Average amount spent on 20 manufactured cigarettes

Average monthly expenditure on manufactured cigarettes

Cost of 100 packs of manufactured cigarettes as a percentage of per capita

Gross Domestic Product (GDP) 20146

572.4

2695.0

11.5%

**

84.7 (82.3-87.2)

48.2 (44.3-52.0)

60.7 (57.1-64.4)

1 Current use refers to daily and less than daily use. 2 Includes manufactured cigarettes and hand-rolled cigarettes. Adapted for other products as per country situation. 3 Current non-users. 4 Current non-smokers. 5 Among those who visited a health care provider in past 12 months. 6 http://data.worldbank.org/indicator/NY.GDP.PCAP.CD, 2014 * During the past 30 days. † Promotions include free cigarette sample, cigarettes at sale prices, coupons for cigarettes, free gifts upon purchase of cigarettes, clothing or other items with cigarette brand name or logo and cigarette promotions in mail. Adults refer to persons age 18-69 years. Data have been weighted to be nationally representative of all men and women age 18-69 years. ** The sample size “n” is less 50.Technical assistance for the survey was provided by the World Health Organization (WHO). This document has been produced with a partial grant from the CDC Foundation, with financial support from the Bloomberg Initiative to Reduce Tobacco Use, a program of Bloomberg Philanthropies. The contents of this document are the sole responsibility of the authors and can under no circumstances be regarded to reflect the positions of the CDC Foundation.


WHO STEPS

Chronic DiseaseRisk Factor Surveillance

TOBACCO POLICYDATA BOOK


Tobacco Policy

Anti-cigarette information

Description: Percentage of all respondents who noticed information in newspapers or magazines, television or radio about the dangers of smoking or that encourages quitting during the past 30 days

Instrument questions:•Duringthepast30days,haveyounoticedinformationaboutthedangersof smoking cigarettes or that encourages quitting through the following media?•Newspapersormagazines

Noticed information in newspapers or magazines about dangers of smoking or that encourages quitting

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 274 67.0 60.4-73.5 450 64.9 59.3-70.6 724 66.0 61.1-71.0

35-44 630 69.3 64.8-73.9 1025 61.4 56.8-66.0 1655 65.5 61.8-69.3

45-54 622 66.8 62.0-71.7 853 57.2 52.3-62.0 1475 62.0 58.0-66.0

55-64 325 68.4 62.5-74.3 410 54.2 48.1-60.3 735 61.6 57.0-66.3

25-64 1851 67.8 64.1-71.4 2738 60.7 57.1-64.4 4589 64.4 61.2-67.6

Noticed information on television about dangers of smoking or that encourages quitting

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 289 89.5 85.1-94.0 491 84.7 80.8-88.7 780 87.2 83.9-90.6

35-44 657 87.1 83.9-90.3 1093 85.4 82.3-88.5 1750 86.3 83.8-88.8

45-54 654 86.6 83.5-89.7 919 85.6 82.4-88.7 1573 86.1 83.5-88.6

55-64 350 86.2 81.8-90.5 453 80.5 76.1-84.9 803 83.4 80.0-86.8

25-64 1950 87.7 85.2-90.2 2956 84.7 82.3-87.2 4906 86.3 84.1-88.4

Noticed information on the radio about dangers of smoking or that encourages quitting

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 271 48.3 41.4-55.3 446 50.7 44.4-57.0 717 49.4 44.3-54.5

35-44 615 53.0 47.9-58.2 984 47.3 42.5-52.0 1599 50.3 46.3-54.3

45-54 604 52.0 46.8-57.2 842 46.9 42.0-51.8 1446 49.4 45.3-53.6

55-64 320 55.9 49.2-62.6 416 45.7 39.7-51.8 736 51.0 45.9-56.1

25-64 1810 51.4 47.4-55.4 2688 48.2 44.3-52.0 4498 49.8 46.4-53.3


Analysis Information:

•Questionsused:TP1a-c•EpiInfoprogramname:TPdanger(unweighted);TPdangerWT(weighted)

Cigarette advertising Description: Percentage of all respondents who noticed advertisements or signs promoting cigarettes in stores where cigarettes are sold during the past 30 days.

Instrument questions:•Duringthepast30days,haveyounoticedanyadvertisementsorsignspromoting cigarettes in stores where cigarettes are sold?

Noticed advertisements or signs promoting cigarettes in stores

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 282 12.7 7.6-17.9 443 7.6 4.9-10.3 725 10.4 7.1-13.6

35-44 647 17.6 13.7-21.6 1027 9.1 6.5-11.6 1674 13.6 10.9-16.2

45-54 633 14.9 10.9-18.9 876 7.5 5.1-9.9 1509 11.2 8.6-13.8

55-64 341 12.6 8.5-16.7 418 6.3 3.3-9.3 759 9.6 6.8-12.4

25-64 1903 14.7 11.9-17.5 2764 7.9 6.1-9.6 4667 11.5 9.5-13.4

Analysis Information: • Questions used: TP2• Epi Info program name: TPcigads (unweighted); TPcigadsWT (weighted)

Instrument questions:•Duringthepast30days,haveyounoticedanyofthefollowingtypesof cigarette promotions?

Noticed free samples of cigarettes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 270 2.4 0.0-5.1 404 0.5 0.0-1.1 674 1.6 0.0-3.2

35-44 613 3.1 1.4-4.7 917 1.0 0.3-1.7 1530 2.1 1.1-3.1

45-54 606 3.9 1.8-5.9 784 1.0 0.3-1.8 1390 2.5 1.3-3.7

55-64 320 1.7 0.2-3.2 384 0.6 0.0-1.7 704 1.2 0.2-2.2

25-64 1809 2.9 1.5-4.3 2489 0.8 0.4-1.2 4298 1.9 1.1-2.8


Noticed sale prices on cigarettes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 267 2.0 0.0-4.0 406 0.2 0.0-0.6 673 1.2 0.0-2.3

35-44 606 3.7 1.9-5.5 917 1.1 0.3-2.0 1523 2.5 1.4-3.6

45-54 601 3.7 1.9-5.5 776 1.0 0.2-1.7 1377 2.4 1.3-3.4

55-64 318 2.0 0.2-3.7 384 1.1 0.0-2.5 702 1.6 0.4-2.7

25-64 1792 2.9 1.8-4.0 2483 0.8 0.3-1.2 4275 1.9 1.3-2.6

Noticed coupons for cigarettes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 265 0.0 0.0-0.0 401 0.0 0.0-0.0 666 0.0 0.0-0.0

35-44 604 1.0 0.1-1.8 901 0.2 0.0-0.5 1505 0.6 0.1-1.1

45-54 597 1.3 0.3-2.2 770 0.2 0.0-0.5 1367 0.7 0.2-1.3

55-64 317 0.4 0.0-1.2 377 0.0 0.0-0.0 694 0.2 0.0-0.7

25-64 1783 0.6 0.3-1.0 2449 0.1 0.0-0.2 4232 0.4 0.2-0.6

Noticed free gifts or special discount offers on other products when buying cigarettes

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 260 0.5 0.0-1.4 398 0.0 0.0-0.0 658 0.3 0.0-0.8

35-44 599 0.8 0.0-1.6 899 0.3 0.0-0.7 1498 0.6 0.1-1.0

45-54 596 1.4 0.3-2.5 769 0.3 0.0-0.7 1365 0.9 0.3-1.5

55-64 316 0.3 0.0-0.8 376 0.1 0.0-0.4 692 0.2 0.0-0.5

25-64 1771 0.8 0.3-1.3 2442 0.2 0.0-0.3 4213 0.5 0.2-0.8

Noticed clothing or other items with a cigarette brand name or logo

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 267 5.0 1.9-8.2 408 1.3 0.0-2.6 675 3.4 1.4-5.3

35-44 610 4.1 2.0-6.3 923 2.6 1.0-4.3 1533 3.4 1.9-5.0

45-54 604 4.0 1.8-6.2 782 1.8 0.4-3.1 1386 2.9 1.5-4.4

55-64 315 1.4 0.1-2.6 376 2.1 0.1-4.0 691 1.7 0.6-2.8

25-64 1796 4.1 2.6-5.7 2489 1.9 1.0-2.8 4285 3.1 2.0-4.2


Noticed cigarette promotions in the mail

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 253 0.0 0.0-0.0 378 0.0 0.0-0.0 631 0.0 0.0-0.0

35-44 561 0.6 0.0-1.3 840 0.4 0.0-0.9 1401 0.5 0.0-0.9

45-54 532 0.6 0.0-1.4 708 0.1 0.0-0.4 1240 0.4 0.0-0.8

55-64 291 0.0 0.0-0.0 352 0.0 0.0-0.0 643 0.0 0.0-0.0

25-64 1637 0.3 0.0-0.6 2278 0.1 0.0-0.3 3915 0.2 0.1-0.4

Analysis Information: •Questionsused:TP3a-TP3f

• Epi Info program name: TPcigpromos (unweighted); TPcigpromosWT(weighted)

Cigarette package health warnings

Description: Percentage of current smokers who noticed health warnings on cigarette packages during the past 30 days.

Instrument questions:•Duringthepast30days,didyounoticeanyhealthwarningsoncigarettepackages?

Current smokers who noticed health warnings on cigarette packages

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 64 83.7 75.2-92.2 0 - - 64 83.7 75.2-92.2

35-44 205 78.4 72.4-84.4 0 - - 205 78.4 72.4-84.4

45-54 195 77.9 71.5-84.2 3 67.6 67.6-67.6 198 77.8 71.5-84.1

55-64 95 73.1 63.3-82.8 0 - - 95 73.1 63.3-82.8

25-64 559 79.3 75.2-83.3 3 67.6 67.6-67.6 562 79.2 75.2-83.3

Analysis Information: •Questionsused:TP4• Epi Info program name: TPwarnings (unweighted); TPwarningsWT(weighted)

Quitting Description: Percentage of current smokers who noticed health warnings on cigarette packages during the past 30 days that thought about quitting due to the health warnings they saw.

Instrument questions:•Duringthepast30days,didyounoticeanyhealthwarningsoncigarettepackages?•Duringthepast30days,havewarninglabelsoncigarettepackagesledyouto think about quitting?


Current smokers who saw health warnings on cigarette packages that thought of quitting

Age Group(years)


n % 95% CI n % 95% CI n % 95% CI

25-34 50 52.5 38.8-66.1 0 - - 50 52.5 38.8-66.1

35-44 152 49.6 40.7-58.5 0 - - 152 49.6 40.7-58.5

45-54 145 62.4 54.0-70.9 1 100 - 146 62.8 54.4-71.1

55-64 66 54.6 41.6-67.6 0 - - 66 54.6 41.6-67.6

25-64 413 54.5 48.5-60.4 1 100 - 414 54.6 48.6-60.5


•Questionsused:TP4,TP5

•EpiInfoprogramname:TPquitting(unweighted);TPquittingWT(weighted)

Cigarette costs Description: Average price paid for 20 manufactured cigarettes, based on the last manufactured cigarette purchase.

Instrument questions:•Thelasttimeyouboughtmanufacturedcigarettesforyourself,howmanyciga-rettes did you buy in total?•Intotal,howmuchmoneydidyoupayforthispurchase?

Average price paid for 20 manufactured cigarettes

Age Group(years)


n Mean LKR

95% CI n Mean LKR

95% CI n Mean LKR

95% CI

25-34 64 604.3 564.0-644.6 0 - - 64 604.3 564.0-644.6

35-44 207 610.1 520.4-699.9 0 - - 207 610.1 520.4-699.9

45-54 184 936.3 233.9-1638.7 2 38.7 33.2-44.2 186 933.3 233.2-1633.4

55-64 86 490.4 439.5-541.3 0 - - 86 490.4 439.5-541.3

25-64 541 683.0 472.3-893.8 2 38.7 33.2-44.2 543 682.5 471.9-893.0


•Questionsused:TP6,TP7

•EpiInfoprogramname:TPcost(unweighted);TPcostWT(weighted)

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